Healthcare Provider Details

I. General information

NPI: 1275131203
Provider Name (Legal Business Name): HELENA DIANE LONGFELLOW APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 PATTON DR
MAHOMET IL
61853-8144
US

IV. Provider business mailing address

1120 N MELVIN ST
GIBSON CITY IL
60936-1477
US

V. Phone/Fax

Practice location:
  • Phone: 217-586-2633
  • Fax: 217-590-0272
Mailing address:
  • Phone: 217-784-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209022187
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022187
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: