Healthcare Provider Details

I. General information

NPI: 1891602793
Provider Name (Legal Business Name): BARBARA LOPEZ APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA BRYANT

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SPINDER DR STE 4015
EAST PEORIA IL
61611-0016
US

IV. Provider business mailing address

133 SPINDER DR STE 4015
EAST PEORIA IL
61611-0016
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-5100
  • Fax: 309-308-5102
Mailing address:
  • Phone: 309-308-5100
  • Fax: 309-308-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036393
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209036393
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: