Individual
BRADLEY REATHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
221 NORTHEAST AVE, PEORIA, IL 61636-0001
(309) 672-5654
Mailing address
1652 BELCLARE RD, NORMAL, IL 61761-4925
(217) 454-0780
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041334740
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209007657
IL
Other
Enumeration date
02/24/2009
Last updated
07/12/2009
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