Healthcare Provider Details

I. General information

NPI: 1033945605
Provider Name (Legal Business Name): DELANIE LYNN FLETCHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SPINDER DR
EAST PEORIA IL
61611-0016
US

IV. Provider business mailing address

26317 OAK LEAF LN
CANTON IL
61520-9302
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-5100
  • Fax:
Mailing address:
  • Phone: 309-338-7038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030506
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: