| Central Illinois Friends Of Pwa, Inc. | |
|
120 Ne Glen Oak Ave Ste 201 Peoria IL 61603-4315 | |
| (309) 431-5880 | |
| Not Available |
| Full Name | Central Illinois Friends Of Pwa, Inc. |
|---|---|
| Speciality | Nurse Practitioner - Community Health |
| Location | 120 Ne Glen Oak Ave Ste 201, Peoria, Illinois |
| Authorized Official Name and Position | Deric Kimler (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3094315880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Illinois Friends Of Pwa, Inc. Po Box 5022 Peoria IL 61601-5022 Ph: (309) 431-5880 | Central Illinois Friends Of Pwa, Inc. 120 Ne Glen Oak Ave Ste 201 Peoria IL 61603-4315 Ph: (309) 431-5880 |
| NPI Number | 1376492306 |
|---|---|
| Provider Enumeration Date | 01/23/2026 |
| Last Update Date | 01/23/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376492306 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| 363LC1500X | Nurse Practitioner - Community Health | (* (Not Available)) | Primary |
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