Healthcare Provider Details

I. General information

NPI: 1477536589
Provider Name (Legal Business Name): LINDA L. MCCALL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA S. MCCALL CNP

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE 300
SPRINGFIELD IL
62704
US

IV. Provider business mailing address

2501 CHATHAM RD STE 300
SPRINGFIELD IL
62704
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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209004577
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: