CENTRAL ILLINOIS FAMILY PRACTICE NPI 1558665596

NPI Information

  • NPI: 1558665596
  • Provider Name: CENTRAL ILLINOIS FAMILY PRACTICE
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 14D2015874
  • Address: 603 N LOGAN AVE
    DANVILLE, IL
    ZIP 61832
  • Phone: (217) 213-5254

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NPI Details

CENTRAL ILLINOIS FAMILY PRACTICE is a family nurse practitioner in Danville, IL. CENTRAL ILLINOIS FAMILY PRACTICE NPI is 1558665596. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

603 N LOGAN AVE
DANVILLE, IL
ZIP 61832-320
Phone: (217) 213-5254
Fax: (217) 213-5240

The provider's authorized official is Michael Curtis Wagner .
The authorized official title is Family Nurse Practitioner and has the following contact phone number (217) 213-5254.

The CLIA number assigned to this NPI record is 14D2015874 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/5/2011 and was last updated on 1/5/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily209003483041ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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