Individual
MELINDA BAHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 MAIN ST STE 630, PEORIA, IL 61602-5024
(309) 672-4433
Mailing address
900 MAIN ST STE 630, PEORIA, IL 61602-5024
(309) 672-4433
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209017573
IL
363LG0600X
Gerontology Nurse Practitioner
209017573
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209017573
LICENSE
IL
Enumeration date
05/08/2018
Last updated
06/23/2022
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