Healthcare Provider Details

I. General information

NPI: 1225851793
Provider Name (Legal Business Name): MICHELLE ALEXANDRIA BOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST
SPRINGFIELD IL
62781-0001
US

IV. Provider business mailing address

813 PULASKI ST
LINCOLN IL
62656-2901
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3030
  • Fax:
Mailing address:
  • Phone: 217-737-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209027477
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: