Healthcare Provider Details

I. General information

NPI: 1043941123
Provider Name (Legal Business Name): CHRISTINA MARIE WEIBLEY FNP-C, FPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E MAIN ST
SALEM IL
62881-2926
US

IV. Provider business mailing address

207 E MAIN ST
SALEM IL
62881-2926
US

V. Phone/Fax

Practice location:
  • Phone: 618-740-2240
  • Fax: 618-740-2241
Mailing address:
  • Phone: 618-740-2240
  • Fax: 618-740-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.004549
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: