Healthcare Provider Details

I. General information

NPI: 1528737897
Provider Name (Legal Business Name): CASEY MIFFLIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY FURNESS

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N RUTLEDGE ST LOWR LEVEL
SPRINGFIELD IL
62702-4968
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-1011
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.023982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: