Healthcare Provider Details

I. General information

NPI: 1336522275
Provider Name (Legal Business Name): CHRISTINA ELIZABETH VENTIMIGLIA-BRANDT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N MAIN ST
DECATUR IL
62523-1206
US

IV. Provider business mailing address

109 E MAPLE ST
GILLESPIE IL
62033-1473
US

V. Phone/Fax

Practice location:
  • Phone: 217-362-6262
  • Fax:
Mailing address:
  • Phone: 217-839-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.012926
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015014624
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number309.009327
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: