Healthcare Provider Details

I. General information

NPI: 1760310221
Provider Name (Legal Business Name): ROBERT JOSEPH DEGITZ PH.D., RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 E MAPLE RIDGE DR
PEORIA IL
61614-7915
US

IV. Provider business mailing address

1819 E MAPLE RIDGE DR
PEORIA IL
61614-7915
US

V. Phone/Fax

Practice location:
  • Phone: 309-231-9708
  • Fax:
Mailing address:
  • Phone: 309-231-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number041-269552
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: