Provider Demographics
NPI:1942308291
Name:MACHENS, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MACHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3089
Mailing Address - Country:US
Mailing Address - Phone:309-624-4000
Mailing Address - Fax:309-624-4010
Practice Address - Street 1:200 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3089
Practice Address - Country:US
Practice Address - Phone:309-624-4000
Practice Address - Fax:309-624-4010
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-185570/209000395363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL500005924 - CA4079Medicare ID - Type UnspecifiedRR
S65306Medicare UPIN
IL809840Medicare ID - Type UnspecifiedGROUP #
ILK22531Medicare ID - Type UnspecifiedINDIVIDUAL
IL503510Medicare ID - Type UnspecifiedINDIVIDUAL #
ILK36003Medicare ID - Type UnspecifiedINDIVIDUAL #