Provider Demographics
NPI:1871660928
Name:MCENERNEY, LINDA NICHOLS (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:NICHOLS
Last Name:MCENERNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4818
Mailing Address - Country:US
Mailing Address - Phone:217-621-2867
Mailing Address - Fax:
Practice Address - Street 1:601 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-4818
Practice Address - Country:US
Practice Address - Phone:217-621-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.0594032080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine