Healthcare Provider Details

I. General information

NPI: 1285893446
Provider Name (Legal Business Name): ROBIN J. WELLS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN J. HICKMAN FNP-BC

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N 1ST ST
SPRINGFIELD IL
62702-3749
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax: 217-535-3665
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041320835
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007140
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: