Healthcare Provider Details

I. General information

NPI: 1285264523
Provider Name (Legal Business Name): DANIEL C LEMAN APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5114 N GLEN PARK PLACE RD STE 110
PEORIA IL
61614-4686
US

IV. Provider business mailing address

5114 N GLEN PARK PLACE RD STE 110
PEORIA IL
61614-4686
US

V. Phone/Fax

Practice location:
  • Phone: 309-683-5600
  • Fax:
Mailing address:
  • Phone: 309-683-5600
  • Fax: 309-683-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277003492
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209020746
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: