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General NPI Number Information
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NPI Number | 1326136870
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Entity Type | Individual
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Provider Name | DENISE K. MEARS FNP-BC, PNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 800 N. 1ST STREET
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City | SPRINGFIELD
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State | IL
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Zip | 62702
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Country | US
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Telephone | 217-528-7541
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 S 6TH ST
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City | SPRINGFIELD
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State | IL
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Zip | 62703-2403
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Country | US
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Telephone | 217-528-7541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209-002366
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License Number State | IL
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