Healthcare Provider Details

I. General information

NPI: 1316253578
Provider Name (Legal Business Name): LINDA S PIETRZAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA S COMPTON NP

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E LAKE SHORE DR SUITE 330
DECATUR IL
62521-3824
US

IV. Provider business mailing address

1900 E LAKE SHORE DR SUITE 330
DECATUR IL
62521-3824
US

V. Phone/Fax

Practice location:
  • Phone: 217-423-2889
  • Fax: 217-423-2923
Mailing address:
  • Phone: 217-423-2889
  • Fax: 217-423-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209006076
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: