Healthcare Provider Details

I. General information

NPI: 1366554305
Provider Name (Legal Business Name): WENDI L CAMPBELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 BURNETT DR
TAYLORVILLE IL
62568-9519
US

IV. Provider business mailing address

1304 BURNETT DR
TAYLORVILLE IL
62568-9519
US

V. Phone/Fax

Practice location:
  • Phone: 217-321-9310
  • Fax: 217-789-1825
Mailing address:
  • Phone: 217-321-9310
  • Fax: 217-789-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209004422
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: