Healthcare Provider Details

I. General information

NPI: 1659525855
Provider Name (Legal Business Name): HOPE PLACHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5114 N GLEN PARK PLACE RD
PEORIA IL
61614-4686
US

IV. Provider business mailing address

5114 N GLEN PARK PLACE RD
PEORIA IL
61614-4686
US

V. Phone/Fax

Practice location:
  • Phone: 309-683-2401
  • Fax:
Mailing address:
  • Phone: 309-683-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085003369
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: