Healthcare Provider Details

I. General information

NPI: 1336051416
Provider Name (Legal Business Name): BRADEE LYNN AAMODT DNP ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST STE 200
PEORIA IL
61606-2035
US

IV. Provider business mailing address

1001 MAIN ST STE 200
PEORIA IL
61606-2035
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-5682
  • Fax: 309-672-3147
Mailing address:
  • Phone: 309-672-5682
  • Fax: 309-672-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209036658
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: