Healthcare Provider Details

I. General information

NPI: 1376977371
Provider Name (Legal Business Name): ANITA D. SCHWAB AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA CLOYD AGACNP

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E MADISON ST STE 1F
SPRINGFIELD IL
62701-3118
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-757-8161
Mailing address:
  • Phone: 217-545-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.010639
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.010639
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: