Healthcare Provider Details

I. General information

NPI: 1841719259
Provider Name (Legal Business Name): CATHERINE D ROLLYSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE BUCHANAN

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 GRIFFIN AVE.
PEKIN IL
61554
US

IV. Provider business mailing address

PO BOX 19248
SPRINGFIELD IL
62794-9248
US

V. Phone/Fax

Practice location:
  • Phone: 309-347-4277
  • Fax: 309-347-4388
Mailing address:
  • Phone: 309-347-4277
  • Fax: 309-347-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016492
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209016492
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: