MEDICARE: SYDNEY GROHLER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209028024	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	309021634	OTHER	IL	CS LICENSE

General Provider Information

NPI Number	:	1336905736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY GROHLER FNP-C

Provider Business Mailing Address
First Line	:	304 W HAY ST STE 213
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62526-4169
Country	:	US
Telephone Number	:	217-876-6640
Fax Number	:	217-876-6645

Provider Business Practice Location Address
First Line	:	304 W HAY ST STE 213
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62526-4169
Country	:	US
Telephone Number	:	217-876-6640
Fax Number	:	217-876-6645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2024
Last Update Date	:	09/25/2024

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Directions to “ SYDNEY GROHLER FNP-C” Practice Location

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