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NPI Code Detail

MEDICARE: RANDI RIGSBY NURSE PRACTITIONER

MEDICARE: RANDI RIGSBY NURSE PRACTITIONER
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
1363LF0000XFamily Nurse Practitioner209007833IL

General Provider Information

NPI Number : 1750617007
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDI RIGSBY NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 1750 E LAKE SHORE DR
Second Line : SUITE 100
City : DECATUR
State : IL
Zip : 62521-3803
Country : US
Telephone Number : 217-475-2880
Fax Number : 217-475-2881
Provider Business Practice Location Address
First Line : 176 W MOUND RD
Second Line :
City : DECATUR
State : IL
Zip : 62526-1964
Country : US
Telephone Number : 217-875-0163
Fax Number : 217-875-9007
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2009
Last Update Date : 01/04/2022

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Directions to “ RANDI RIGSBY NURSE PRACTITIONER” Practice Location

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