Healthcare Provider Details

I. General information

NPI: 1467860445
Provider Name (Legal Business Name): CHRISTIE ROCKE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIE BRADY

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE SUITE 3400
NORMAL IL
61761-3551
US

IV. Provider business mailing address

1302 FRANKLIN AVE SUITE 3400
NORMAL IL
61761-3551
US

V. Phone/Fax

Practice location:
  • Phone: 309-556-8300
  • Fax: 309-556-8295
Mailing address:
  • Phone: 309-556-8300
  • Fax: 309-556-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011792
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011792
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: