Individual
ETHAN SPERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-2000
Mailing address
203 PINE CIR, EUREKA, IL 61530-1639
(309) 361-1687
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209-033064
IL
Other
Enumeration date
08/27/2025
Last updated
08/27/2025
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