Healthcare Provider Details

I. General information

NPI: 1255647962
Provider Name (Legal Business Name): KATHY J SCHAFER RN, MSN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL DR SUITE 300
DECATUR IL
62526-6303
US

IV. Provider business mailing address

1 MEMORIAL DR SUITE 300
DECATUR IL
62526-6303
US

V. Phone/Fax

Practice location:
  • Phone: 217-875-5545
  • Fax: 217-875-4680
Mailing address:
  • Phone: 217-875-5545
  • Fax: 217-875-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209.008352
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: