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General NPI Number Information
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NPI Number | 1528886330
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Entity Type | Individual
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Provider Name | SARAH BULEY APN
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Gender | Female
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 200 E PENNSYLVANIA AVE
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City | PEORIA
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State | IL
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Zip | 61603-3089
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Country | US
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Telephone | 309-624-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 14331 EGG RANCH RD
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City | PEKIN
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State | IL
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Zip | 61554-8494
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Country | US
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Telephone | 309-224-0572
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209030679
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 041469967
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License Number State | IL
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