Healthcare Provider Details

I. General information

NPI: 1619963881
Provider Name (Legal Business Name): KRISTI S KROENLEIN MS FNP APN BC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BROADWAY ST
PEKIN IL
61554-3905
US

IV. Provider business mailing address

2401 BROADWAY
PEKIN IL
61554
US

V. Phone/Fax

Practice location:
  • Phone: 309-478-1700
  • Fax: 309-478-1701
Mailing address:
  • Phone: 309-478-1700
  • Fax: 309-478-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: