Healthcare Provider Details

I. General information

NPI: 1720353691
Provider Name (Legal Business Name): TAMMY SUE NEYS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

530 NE GLEN OAK
PEORIA IL
61637
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-6892
  • Fax: 309-655-3739
Mailing address:
  • Phone: 309-655-6892
  • Fax: 309-655-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209009115
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: