Healthcare Provider Details

I. General information

NPI: 1932285491
Provider Name (Legal Business Name): LINDA HAILE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E. WINDSOR ROAD OB/GYN
URBANA IL
61802
US

IV. Provider business mailing address

P.O. BOX 6002
URBANA IL
61803-6002
US

V. Phone/Fax

Practice location:
  • Phone: 217-255-9600
  • Fax: 217-255-9650
Mailing address:
  • Phone: 217-326-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209000691
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: