Healthcare Provider Details

I. General information

NPI: 1720274012
Provider Name (Legal Business Name): LEANNE M NOVAR FNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEANNE M MAST

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH ST
SPRINGFIELD IL
62702-5238
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-747-1351
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-757-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209006679
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209-013031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: