CONNIE H REQUARTH (NPI# 1467462085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467462085 |
| Entity Type | Individual |
| Full Name | CONNIE H REQUARTH |
| Credential | APN |
| Practice Address |
2905 North Main Street Decatur IL 62526-4274 |
| Practice Telephone | 2178779117 |
| Practice Fax Number | 2178773078 |
| Mailing Telephone | 2178779117 |
| Mailing Fax Number | 2178773082 |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2011-11-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
041135327 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE RR | P00238267 | 01 |
| Street Address |
2905 NORTH MAIN STREET |
| City | DECATUR |
| State | IL |
| Zip Code | 62526-4274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100804 | Coalition | Non-emergency Medical Transport (VAN) | 2375 N Longwood Dr, Decatur, IL 62526 | 2018-07-04 |
| 1881116820 | Bria N Howard | Nurse's Aide | 606 E Warren St. Apt 609, Decatur, IL 62526 | 2017-07-12 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1083166326 | Whitney Miller | Pharmacist | 225 East Ash Ave, Decatur, IL 62526 | 2016-11-03 |
| 1487053369 | Central Illinois Health Associates, Inc | Preferred Provider Organization | 2300 N. Edward Street, Decatur, IL 62526 | 2014-08-18 |
| 1659787893 | Stephanie Marie Kanitsch | Obstetrics & Gynecology | 544 W Pershing Rd Ste A, Decatur, IL 62526 | 2014-07-09 |
| 1497169973 | Brian Hassinger | Audiologist-Hearing Aid Fitter | 2605 N Water St Ste 101, Decatur, IL 62526 | 2014-06-12 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1558639005 | Larry Lee Christensen | Pharmacist | 225 Ash Ave, Decatur, IL 62526 | 2011-12-12 |
| 1174821540 | Nathan Pyle | Internal Medicine | 2 Memorial Dr Ste 101, Decatur, IL 62526 | 2011-03-08 |
| Find all providers in zip 62526 | ||||
| Taxonomy Code | 363LW0102X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Women's Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497368328 | Jennifer Cobb | Nurse Practitioner | 130 Champlain St, Decatur, GA 30030-1803 | 2020-08-29 |
| 1992235469 | Nijah Alish Chapman | Nurse Practitioner | 2665 N Decatur Rd Ste 255, Decatur, GA 30033-6176 | 2017-06-15 |
| 1598041741 | Netcare Medical Clinic Decatur, Inc | Nurse Practitioner | 4284 Memorial Dr Ste C, Suite C, Decatur, GA 30032-1220 | 2011-11-01 |
| 1952603201 | Surayyah W. Fareed | Nurse Practitioner | 2855 Candler Rd Ste 14, Decatur, GA 30034-1415 | 2010-11-18 |
| 1801103387 | State of Alabama Department of Public Health | Nurse Practitioner | 510 Cherry St. Ne, Decatur, AL 35602-1628 | 2010-09-07 |
| 1871502005 | Evelyn R Morales | Nurse Practitioner | 2675 N Decatur Rd Ste 301, Suite 301, Decatur, GA 30033-6132 | 2006-08-05 |
| 1497354054 | Hannah Elizabeth Bergbower | Nurse Practitioner | 2675 N Decatur Rd Ste 607, Decatur, GA 30033-6134 | 2020-10-23 |
| 1912325267 | Diane Rainford | Nurse Practitioner | 3110 Clifton Springs Rd, Decatur, GA 30034-4600 | 2014-04-03 |
| 1902220429 | Andi Christine Petito | Nurse Practitioner | 3110 Clifton Springs Rd, Decatur, GA 30034-4600 | 2014-02-05 |
| 1104264183 | Jessica Je'nae Thomas | Nurse Practitioner | 1458 Church St Ste B, Decatur, GA 30030-1672 | 2013-06-12 |
| Find all providers in DECATUR | ||||
Please comment or provide details below to improve the information on CONNIE H REQUARTH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.