Healthcare Provider Details

I. General information

NPI: 1760940712
Provider Name (Legal Business Name): EMILY ANN NTOR-UE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 E LAKE SHORE DR STE 105
DECATUR IL
62521-3800
US

IV. Provider business mailing address

1770 E LAKE SHORE DR STE 105
DECATUR IL
62521-3800
US

V. Phone/Fax

Practice location:
  • Phone: 217-422-6100
  • Fax:
Mailing address:
  • Phone: 217-422-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.018942
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number209.018942
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: