Provider Demographics
NPI:1629263793
Name:SCHREY, DONITA (NP)
Entity Type:Individual
Prefix:
First Name:DONITA
Middle Name:
Last Name:SCHREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E MASON ST
Mailing Address - Street 2:SUITE 4P57
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1034
Mailing Address - Country:US
Mailing Address - Phone:217-788-0706
Mailing Address - Fax:217-525-2535
Practice Address - Street 1:2801 MATHERS RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7064
Practice Address - Country:US
Practice Address - Phone:217-241-3586
Practice Address - Fax:217-726-5867
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006748207RI0011X, 363LA2100X, 363LA2100X
IL277001091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00444962OtherRAILROAD MEDICARE
ILP00444962OtherRAILROAD MEDICARE
ILP00444962OtherRAILROAD MEDICARE
IL$$$$$$$$$001Medicaid