Healthcare Provider Details

I. General information

NPI: 1609657980
Provider Name (Legal Business Name): NP WOMEN'S HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/28/2023
Certification Date: 10/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10326 N JULIET CT STE A
PEORIA IL
61615-1116
US

IV. Provider business mailing address

10326 N JULIET CT STE A
PEORIA IL
61615-1116
US

V. Phone/Fax

Practice location:
  • Phone: 309-570-1016
  • Fax: 309-570-1017
Mailing address:
  • Phone: 309-570-1016
  • Fax: 309-570-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH RENEE TUCKER
Title or Position: CO-OWNER
Credential: WHNP
Phone: 309-840-3008