Healthcare Provider Details

I. General information

NPI: 1629534227
Provider Name (Legal Business Name): SONIA LEE BEHRENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 N 24TH ST
QUINCY IL
62301-3140
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 217-214-6300
  • Fax:
Mailing address:
  • Phone: 217-223-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277004461
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: