Healthcare Provider Details

I. General information

NPI: 1245464122
Provider Name (Legal Business Name): KATIE T. CRAWLEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE T. GUALANDRI

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 N KNOXVILLE AVE
PEORIA IL
61603-1747
US

IV. Provider business mailing address

2901 N KNOXVILLE AVE
PEORIA IL
61603-1747
US

V. Phone/Fax

Practice location:
  • Phone: 309-688-7010
  • Fax: 309-688-7044
Mailing address:
  • Phone: 309-688-7010
  • Fax: 309-688-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036.132790
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036132790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: