Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Jun 18, 2025
License(s)
209032356 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 330 SW ADAMS ST | Peoria, IL 61602-1502 | 309-308-3310 |
| MAILING | 330 SW ADAMS ST | Peoria, IL 61602-1502 |
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.