Healthcare Provider Details

I. General information

NPI: 1477465680
Provider Name (Legal Business Name): ERIC K NYABERI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5414 N CASTLEBERRY DR
PEORIA IL
61615-9318
US

IV. Provider business mailing address

5414 N CASTLEBERRY DR
PEORIA IL
61615-9318
US

V. Phone/Fax

Practice location:
  • Phone: 309-642-9371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1002458-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: