Healthcare Provider Details

I. General information

NPI: 1114115920
Provider Name (Legal Business Name): AIRN A ETHERTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIRN A ENGLISH FNP-BC

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH ST
SPRINGFIELD IL
62702-5238
US

IV. Provider business mailing address

520 N 4TH ST PO BOX 19670
SPRINGFIELD IL
62702-5238
US

V. Phone/Fax

Practice location:
  • Phone: 217-757-8100
  • Fax: 217-757-8161
Mailing address:
  • Phone: 217-757-8100
  • Fax: 217-757-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209006215
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: