Healthcare Provider Details

I. General information

NPI: 1700403516
Provider Name (Legal Business Name): CHRISTINA MARIE SPURGEON MSN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

19213 N PRINCEVILLE JUBILEE RD
PRINCEVILLE IL
61559-9401
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-0629
  • Fax:
Mailing address:
  • Phone: 309-251-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number209020908
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: