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General NPI Number Information
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NPI Number | 1477533057
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Entity Type | Individual
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Provider Name | SUSAN SPHAR CNM
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Gender | Female
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 5114 N GLEN PARK PLACE RD SUITE 220
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City | PEORIA
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State | IL
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Zip | 61614-4686
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Country | US
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Telephone | 309-692-2025
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Fax | 309-621-4646
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Provider Business Mailing Address
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Address Line | 8600 N. ROUTE 91 SUITE 330
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City | PEORIA
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State | IL
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Zip | 61615
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Country | US
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Telephone | 309-692-2025
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Fax | 309-621-4646
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 209001042APN
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License Number State | IL
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