Healthcare Provider Details

I. General information

NPI: 1548882186
Provider Name (Legal Business Name): LINDA M STRICKLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2020
Last Update Date: 05/16/2020
Certification Date: 05/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 S TAYLORVILLE RD
DECATUR IL
62521-3951
US

IV. Provider business mailing address

1622 S TAYLORVILLE RD
DECATUR IL
62521-3951
US

V. Phone/Fax

Practice location:
  • Phone: 309-431-2051
  • Fax:
Mailing address:
  • Phone: 217-454-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number03405645
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: