Healthcare Provider Details

I. General information

NPI: 1083736391
Provider Name (Legal Business Name): JULIANNA M. WILLEFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N 1ST ST SUITE 101
SPRINGFIELD IL
62702-3748
US

IV. Provider business mailing address

710 N 8TH ST
SPRINGFIELD IL
62702-6324
US

V. Phone/Fax

Practice location:
  • Phone: 217-757-7700
  • Fax: 217-757-7799
Mailing address:
  • Phone: 217-525-1064
  • Fax: 217-525-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number41223452
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: