Active NPI
Connie H Requarth, APN
- Women's Health Nurse Practitioner
- Decatur, IL
National Provider Identifier
1467462085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 041135327
- Practice address
- 2905 North Main Street
Decatur, IL 62526-4274 - Phone
- (217) 877-9117
- Fax
- (217) 877-3078
- NPI assigned
- Aug 8, 2006
- 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 |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 041135327 | IL | Primary |
Addresses
Primary practice location
2905 North Main Street
Decatur, IL 62526-4274
Mailing address
2905 North Main Street
Decatur, IL 62526-4274
Phone (217) 877-9117
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00238267 | Other | IL | MEDICARE RR |
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041135327 | IL | MD | Women's Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322438400000",
"number": "1467462085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2905 NORTH MAIN STREET",
"city": "DECATUR",
"state": "IL",
"postal_code": "625264274",
"telephone_number": "217-877-9117",
"fax_number": "217-877-3082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2905 NORTH MAIN STREET",
"city": "DECATUR",
"state": "IL",
"postal_code": "625264274",
"telephone_number": "217-877-9117",
"fax_number": "217-877-3078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REQUARTH",
"first_name": "CONNIE",
"middle_name": "H",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-08",
"last_updated": "2011-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "IL",
"license": "041135327",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR",
"identifier": "P00238267",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.