Healthcare Provider Details

I. General information

NPI: 1881855450
Provider Name (Legal Business Name): JUDY MARIE TONRY APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 W LEGACY POINTE DR
SPRINGFIELD IL
62711-6444
US

IV. Provider business mailing address

1118 W LEGACY POINTE DR
SPRINGFIELD IL
62711-6444
US

V. Phone/Fax

Practice location:
  • Phone: 217-787-8870
  • Fax: 217-787-6158
Mailing address:
  • Phone: 217-787-8870
  • Fax: 217-787-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209003244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: