Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Critical Care Medicine
Enumerated
Jul 1, 2021
License(s)
H163545 (IA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 15804 ROUTE 84 N | East Moline, IL 61244-9735 | 612-990-2327 |
| LOCATION | 221 NE GLEN OAK AVE | Peoria, IL 61636-0001 | 309-672-5522 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.