Provider Demographics
NPI:1417147927
Name:MOGREN, CHRISTOPHER L (CFNP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:MOGREN
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19639
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9639
Mailing Address - Country:US
Mailing Address - Phone:217-545-7578
Mailing Address - Fax:217-545-1884
Practice Address - Street 1:751 N RUTLEDGE ST
Practice Address - Street 2:ROOM 1100
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4909
Practice Address - Country:US
Practice Address - Phone:217-545-0173
Practice Address - Fax:217-545-5459
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00460018OtherRAILROAD MEDICARE
ILP00460018OtherRAILROAD MEDICARE
ILK48670Medicare PIN