Healthcare Provider Details

I. General information

NPI: 1871424812
Provider Name (Legal Business Name): EMILY CORRINE PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE
NORMAL IL
61761-3551
US

IV. Provider business mailing address

1302 FRANKLIN AVE
NORMAL IL
61761-3551
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-2920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.496941
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: