Doctor Name: | EMILY CREBO |
NPI Number: | 1003821448 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 209005763 |
Business Practice Address: | 610 Park Ave Pekin, IL - 615544650 |
Business Phone Number: | 3093467776 |
Business Fax Number: | |
Mailing Address: | 5405 N Knoxville Ave, PEORIA |
State: | IL |
Postal Code: | 616145016 |
Phone Number: | 3096914410 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209005763 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |