EDWARD E ETHERTON (NPI# 1053662783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053662783 |
| Entity Type | Individual |
| Full Name | EDWARD E ETHERTON |
| Credential | NP |
| Practice Address |
1701 W Garden St Peoria IL 61605-3531 |
| Practice Telephone | 3096807600 |
| Practice Fax Number | 3096807637 |
| Mailing Telephone | 3096807600 |
| Mailing Fax Number | 3096807686 |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2013-11-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 209-009512 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1701 W GARDEN ST |
| City | PEORIA |
| State | IL |
| Zip Code | 61605-3531 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871599522 | David Carl Gregory | Family Medicine | 1701 W Garden St, Peoria, IL 61605-3531 | 2005-06-27 |
| 1144793639 | John Alexander-blair Ramirez | Social Worker | 1701 W Garden St, Peoria, IL 61605-3531 | 2019-01-07 |
| 1376925586 | Shannon Diann Pyle | Nurse Practitioner | 1701 W Garden St, Peoria, IL 61605-3531 | 2015-06-24 |
| 1487054425 | Kathryn M Endress | Nurse Practitioner | 1701 W Garden St, Peoria, IL 61605-3531 | 2014-08-27 |
| 1063825446 | Marcus Ismedhi Mutidjo | Nurse Practitioner | 1701 W Garden St, Peoria, IL 61605 | 2014-06-03 |
| 1710210711 | Amy M. Light | Counselor | 1701 W Garden St, Peoria, IL 61605-3531 | 2009-09-09 |
| 1902951957 | Tina R Saddler | Nurse Practitioner | 1701 W Garden St, Peoria, IL 61605-3531 | 2007-01-23 |
| 1467546218 | Gregg D Stoner | Family Medicine | 1701 W Garden St, Peoria, IL 61605-3531 | 2006-10-03 |
| 1790889392 | Sandra K. Leman | Physician Assistant | 1701 W Garden St, Peoria, IL 61605-3531 | 2006-09-12 |
| 1629092226 | Thembi A Conner-garcia | Internal Medicine | 1701 W Garden St, Peoria, IL 61605 | 2006-07-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386131878 | Nicholas Anthony Helling | Physical Therapist | 518 W Romero B Garret Ave, Poeria, IL 61605 | 2018-04-19 |
| 1891241022 | Peoria Slf Lp | Assisted Living Facility | 518 West Romeo B. Garrett Avenue, Peoria, IL 61605 | 2016-08-28 |
| 1932479664 | Michelle L Whitelow | Nurse Practitioner | 711 W John Gwynn Jr. Avenue, Peoria, IL 61605 | 2012-01-11 |
| 1982852877 | Jason M Anane-sefah | Orthopaedic Surgery | 303 North Kumpf Boulevard, Peoria, IL 61605 | 2008-09-04 |
| 1902098908 | Calvary Elderly Home Help Program | Home Health | 1709 W Lincoln Ave, Peoria, IL 61605 | 2007-08-14 |
| 1023104437 | Thomas Anderson | Optometrist | 710 W Third Avenue, Peoria, IL 61605 | 2006-10-04 |
| 1841382298 | Devashish Agarwal | Family Medicine | 1701 W. Garden Street, Peoria, IL 61605 | 2006-09-29 |
| 1497763197 | Larry T Rolle | Pharmacist | 411 Martin Luther King Dr., Peoria, IL 61605 | 2006-08-04 |
| 1568404762 | Joseph P Kelly Iv | Physical Therapist | 303 N. Kumpf Blvd, Peoria, IL 61605 | 2006-06-12 |
| 1003861634 | Patrick William Elwood | Neurological Surgery | 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605 | 2006-05-23 |
| Find all providers in zip 61605 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962034215 | Lia Doh | Nurse Practitioner | 8357 W Rosewood Ln, Peoria, AZ 85383-3869 | 2020-02-05 |
| 1285274027 | Chauntel M Nessmith | Nurse Practitioner | 7540 W Jenan Dr, Peoria, AZ 85345-1367 | 2020-01-09 |
| 1003450925 | Kimberly Ann Flores | Nurse Practitioner | 12118 W Avenida Del Rey, Peoria, AZ 85383-5819 | 2019-11-04 |
| 1821630666 | Leesa K Jost | Nurse Practitioner | 8914 N Prairie Pointe Rd, Peoria, IL 61615-1574 | 2019-10-14 |
| 1942842018 | Tamarra Lynn Subyantoro | Nurse Practitioner | 5114 N Glen Park Place Rd Ste 110, Peoria, IL 61614-4686 | 2019-10-10 |
| 1255981593 | Eunmee Hong | Nurse Practitioner | 21369 N 79th Dr, Peoria, AZ 85382-4453 | 2019-09-18 |
| 1295297737 | Tasha R Besser | Nurse Practitioner | 5114 N Glen Park Place Rd Ste 220, Peoria, IL 61614-4686 | 2019-04-03 |
| 1669936506 | Kristin Danielle Downs | Nurse Practitioner | 10408 N Centerway Dr, Peoria, IL 61615-1234 | 2019-01-24 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1538665609 | Tara Moore | Nurse Practitioner | 10408 N Centerway Dr Ste Cde, Peoria, IL 61615-1234 | 2018-04-05 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.