Individual
EDWARD E ETHERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1701 W GARDEN ST, PEORIA, IL 61605-3531
(309) 680-7600
(309) 680-7637
Mailing address
1701 W GARDEN ST, PEORIA, IL 61605-3531
(309) 680-7600
(309) 680-7686
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-009512
IL
Other
Enumeration date
09/20/2012
Last updated
11/18/2013
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