Healthcare Provider Details

I. General information

NPI: 1801308911
Provider Name (Legal Business Name): MICHELLE WERNERT-DODD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 6TH STREET FRONTAGE RD E
SPRINGFIELD IL
62703-5162
US

IV. Provider business mailing address

5850 6TH STREET FRONTAGE RD E
SPRINGFIELD IL
62703-5162
US

V. Phone/Fax

Practice location:
  • Phone: 217-529-5046
  • Fax:
Mailing address:
  • Phone: 217-529-5046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277003988
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: