Provider Demographics
NPI:1780123091
Name:DEMIERRE, CHRISTIN (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:
Last Name:DEMIERRE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 N CONVENT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1081
Mailing Address - Country:US
Mailing Address - Phone:815-937-5200
Mailing Address - Fax:815-937-2063
Practice Address - Street 1:1615 N CONVENT ST STE 1
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1081
Practice Address - Country:US
Practice Address - Phone:815-937-5200
Practice Address - Fax:815-937-2063
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily