Individual
C DIANE REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
900 MAIN ST, PEORIA, IL 61602-1005
(309) 353-0388
Mailing address
12156 N TALL TREES DR, DUNLAP, IL 61525-9533
(309) 264-0578
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
277000768
IL
363LA2100X
Acute Care Nurse Practitioner
277.000768
IL
Other
Enumeration date
12/17/2010
Last updated
08/24/2023
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