Healthcare Provider Details

I. General information

NPI: 1679256093
Provider Name (Legal Business Name): LEAH MARIE CUMMINGS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 W MARION AVE
FORSYTH IL
62535-1018
US

IV. Provider business mailing address

9013 E SCHOOL RD
ARGENTA IL
62501-8045
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-0065
  • Fax: 217-666-9967
Mailing address:
  • Phone: 217-383-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209.028025
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209028025
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209028025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: