Healthcare Provider Details

I. General information

NPI: 1780356089
Provider Name (Legal Business Name): ANDREW BIFULK ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OSF SAINT FRANCIS MEDICAL CENTER 530 NE GLEN OAK AVENUE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

2017 E RIDGE RD
BELOIT WI
53511-3914
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-2000
  • Fax:
Mailing address:
  • Phone: 608-316-0163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209024142
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: