MEDICARE: TRICIA RENAE MALOTT-STURM FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.022095	IL

General Provider Information

NPI Number	:	1063011674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA RENAE MALOTT-STURM FNP-C

Provider Business Mailing Address
First Line	:	100 N MAIN ST
Second Line	:
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-2533
Country	:	US
Telephone Number	:	309-966-9984
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 OTTAWA CT
Second Line	:
City	:	MARQUETTE HEIGHTS
State	:	IL
Zip	:	61554-1401
Country	:	US
Telephone Number	:	309-360-1216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	05/26/2026

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