Healthcare Provider Details

I. General information

NPI: 1659071868
Provider Name (Legal Business Name): CATALINA WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W HAY ST STE 212
DECATUR IL
62526-6376
US

IV. Provider business mailing address

4455 E US ROUTE 36
DECATUR IL
62521-5003
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-4390
  • Fax: 217-876-4395
Mailing address:
  • Phone: 217-876-5320
  • Fax: 217-876-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209026829
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number209026829
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: