Individual
JULIE L O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN, CNS
Contact information
Practice address
8600 N STATE ROUTE 91, PEORIA, IL 61615-9541
(309) 683-5409
(309) 683-5428
Mailing address
8600 N ROUTE 91, PEORIA, IL 61615
(309) 683-5051
(309) 683-5428
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
209006476
IL
364S00000X
Clinical Nurse Specialist
209-002981
IL
364SG0600X
Gerontology Clinical Nurse Specialist
209002981
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
809840
MEDICARE GROUP PTAN
IL
Enumeration date
03/15/2007
Last updated
12/12/2024
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