Individual
HOLLY VANNITAMBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6339 N BIG HOLLOW RD, PEORIA, IL 61615-2907
(309) 693-3315
(309) 693-9385
Mailing address
815 MAIN ST STE A, PEORIA, IL 61602-1080
(309) 672-4977
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036150954
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036.150954
—
IL
01
—
125.071177
LICENSE
—
Enumeration date
06/20/2017
Last updated
07/27/2020
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