Healthcare Provider Details

I. General information

NPI: 1396396024
Provider Name (Legal Business Name): KRISTIN T ANSTEATT APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 07/30/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W NORTHMOOR RD
PEORIA IL
61614-3542
US

IV. Provider business mailing address

427 W NORTHMOOR RD
PEORIA IL
61614-3542
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-5337
  • Fax: 309-693-3913
Mailing address:
  • Phone: 309-692-5337
  • Fax: 309-693-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019571
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041417659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: