Individual
DEENA R RAITHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
200 E PENNSYLVANIA AVE STE 105, PEORIA, IL 61603-3045
(309) 655-7888
(309) 655-7905
Mailing address
200 E PENNSYLVANIA AVE STE 105, PEORIA, IL 61603-3045
(309) 655-7888
(309) 655-7905
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-013127
IL
Other
Enumeration date
10/14/2015
Last updated
10/14/2015
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