Healthcare Provider Details

I. General information

NPI: 1073501078
Provider Name (Legal Business Name): JUNITTA CYRINE STIEREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 S MAIN ST
VIRGINIA IL
62691-1571
US

IV. Provider business mailing address

850 E MADISON ST
SPRINGFIELD IL
62702-5500
US

V. Phone/Fax

Practice location:
  • Phone: 217-452-3057
  • Fax: 217-452-7245
Mailing address:
  • Phone: 217-744-9355
  • Fax: 217-528-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209001823
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: