Healthcare Provider Details

I. General information

NPI: 1366467755
Provider Name (Legal Business Name): KRISTI M TOENNIES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W. MCKINLEY AVE STE 1
DECATUR IL
62526
US

IV. Provider business mailing address

1052 MARTIN LUTHER KING DR SUITE 2
CENTRALIA IL
62801-3002
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-6600
  • Fax: 217-876-6606
Mailing address:
  • Phone: 618-436-5410
  • Fax: 618-436-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number137122
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: