Healthcare Provider Details

I. General information

NPI: 1073815403
Provider Name (Legal Business Name): EVELYN E SHEAFF FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 S MAIN ST
VIRGINIA IL
62691-1519
US

IV. Provider business mailing address

331 S MAIN ST
VIRGINIA IL
62691-1519
US

V. Phone/Fax

Practice location:
  • Phone: 217-452-3057
  • Fax:
Mailing address:
  • Phone: 217-452-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209002634
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: