Active NPI
Christina B Nulty, M.D.
- Adolescent Medicine (Internal Medicine) Physician
- Peoria, IL
National Provider Identifier
1114142643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adolescent Medicine (Internal Medicine) Physician
- Practice address
- 912 N Elmwood Ave
Peoria, IL 61625-0001 - Phone
- (309) 677-2700
- Fax
- (309) 677-3534
- NPI assigned
- Apr 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adolescent Medicine (Internal Medicine) Physician | 207RA0000X | IL | Primary |
Addresses
Primary practice location
912 N Elmwood Ave
Peoria, IL 61625-0001
Mailing address
1116 Dieble Rd
Washington, IL 61571-9615
Phone (309) 677-2700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-086595 | IL | MD | Adolescent Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114142643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1116 DIEBLE RD",
"city": "WASHINGTON",
"state": "IL",
"postal_code": "615719615",
"telephone_number": "309-677-2700",
"fax_number": "309-677-3534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 N ELMWOOD AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616250001",
"telephone_number": "309-677-2700",
"fax_number": "309-677-3534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NULTY",
"first_name": "CHRISTINA",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RA0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Adolescent Medicine",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.