Healthcare Provider Details

I. General information

NPI: 1013288646
Provider Name (Legal Business Name): ST. MARGARET'S HEALTH-PERU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E HIGH ST
HENNEPIN IL
61327-9424
US

IV. Provider business mailing address

1305 6TH ST
PERU IL
61354-2759
US

V. Phone/Fax

Practice location:
  • Phone: 815-925-7032
  • Fax: 815-925-7463
Mailing address:
  • Phone: 815-223-3500
  • Fax: 815-780-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DORI BONNELL
Title or Position: DIRECTOR OF PHYSICIAN PRACTICES
Credential:
Phone: 815-780-3222