Healthcare Provider Details

I. General information

NPI: 1659662070
Provider Name (Legal Business Name): ERIN JEAN OVERCASH W.H.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7309 N KNOXVILLE AVE SUITE 300
PEORIA IL
61614-2085
US

IV. Provider business mailing address

PO BOX 10033
PEORIA IL
61612-0033
US

V. Phone/Fax

Practice location:
  • Phone: 309-671-5100
  • Fax: 309-671-5115
Mailing address:
  • Phone: 309-671-5100
  • Fax: 309-671-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.008771
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: