Healthcare Provider Details

I. General information

NPI: 1063872836
Provider Name (Legal Business Name): EVANNE M IHNKEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVANNE M HILL PA-C

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E PENNSYLVANIA AVE
PEORIA IL
61603-3089
US

IV. Provider business mailing address

200 E PENNSYLVANIA AVE
PEORIA IL
61603-3089
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010198
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2016006861
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: