Healthcare Provider Details

I. General information

NPI: 1336642867
Provider Name (Legal Business Name): CHRISTINA ROVEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA HERMAN

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 ATLANTA ST
SPRINGFIELD IL
62707-8801
US

IV. Provider business mailing address

PO BOX 3428
SPRINGFIELD IL
62708-3428
US

V. Phone/Fax

Practice location:
  • Phone: 217-588-7400
  • Fax: 217-588-7439
Mailing address:
  • Phone: 800-577-5368
  • Fax: 217-757-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017421
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: