Individual
BETHANY JOY WINFREY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2321 N WISCONSIN AVE, PEORIA, IL 61603-5613
(309) 680-7600
(309) 681-8620
Mailing address
2321 N WISCONSIN AVE, PEORIA, IL 61603-5613
(309) 680-7600
(309) 681-8620
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-013059
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209-013059
IL APN LICENSE
IL
Enumeration date
08/14/2015
Last updated
09/15/2023
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