Healthcare Provider Details

I. General information

NPI: 1831161272
Provider Name (Legal Business Name): MARY ANN LINER APN NP RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 NE JEFFERSON AVE
PEORIA IL
61603-3843
US

IV. Provider business mailing address

9 APPLE TREE LN
EAST PEORIA IL
61611-3501
US

V. Phone/Fax

Practice location:
  • Phone: 309-673-0907
  • Fax: 309-673-6914
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: