Provider Demographics
NPI:1518044221
Name:IRLE, LINDA (NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:IRLE
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 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:1701 W CURTIS ROAD
Practice Address - Street 2:FAMILY MEDICINE/CONVENIENT CARE
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822
Practice Address - Country:US
Practice Address - Phone:217-365-6203
Practice Address - Fax:217-326-1234
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000107363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0533210001OtherDMERC
ILP65128Medicare UPIN
65128Medicare UPIN
6447860004Medicare NSC
ILK11108Medicare PIN
IL0533210001OtherDMERC