Individual
PHILLIS A DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8818
(309) 624-8820
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8818
(309) 624-8820
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-008776
IL
Other
Enumeration date
04/24/2012
Last updated
04/24/2012
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