ERICA M DEFORD (NPI# 1306020334) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1306020334 |
Entity Type | Individual |
Full Name | ERICA M DEFORD |
Other Name | ERICA M PLATTNER |
Credential | PA |
Practice Address |
2805 N Knoxville Ave Peoria IL 61604-2869 |
Practice Telephone | 3096249400 |
Practice Fax Number | 3096242280 |
Mailing Telephone | 3096249400 |
Mailing Fax Number | 3096242280 |
Enumeration Date | 2007-12-27 |
Last Update Date | 2009-10-02 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
085003126 | IL | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TAX ID | 37-1221637 | 01 | |
IL | MEDICARE GROUP PIN | 776530 | 01 |
IL | MEDICARE GROUP PTAN | 809840 | 01 |
Street Address |
2805 N KNOXVILLE AVE |
City | PEORIA |
State | IL |
Zip Code | 61604-2869 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639168222 | Gloria Isabel Diaz | Internal Medicine | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2005-10-17 |
1982985339 | Scott A Gonia | Clinical Nurse Specialist | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2011-08-30 |
1467575092 | Melissa J. Dye | Clinical Nurse Specialist | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2007-04-09 |
1912097205 | Michael F. Shekleton | Internal Medicine | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2006-10-15 |
1447351077 | Fritz-henry Volmar | Internal Medicine | 2805 N Knoxville Ave, Suite 209, Peoria, IL 61604-2869 | 2006-09-26 |
1790727410 | Susan M Mettille | Physician Assistant | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2006-06-11 |
1881635605 | Michael D Cashman | Internal Medicine | 2805 N Knoxville Ave, Peoria, IL 61604-2869 | 2006-06-10 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205357928 | Nydia I Rodriguez | Nurse's Aide | 3305 N Finnell Ave, Peoria, IL 61604 | 2017-07-03 |
1720327976 | Brin Diagnostics Inc. | Clinical Medical Laboratory | 3216 W Kenwood, West Peoria, IL 61604 | 2013-02-07 |
1225373715 | Ngocyen Thi Ngo | Pharmacist | 2515 N Knoxville Avenue, Peoria, IL 61604 | 2012-12-10 |
1194027003 | Schelly Chiropractic, Inc | Chiropractor | 1208 W Loucks, Peoria, IL 61604 | 2010-11-29 |
1770755852 | Dental Sealants & More | Dentist | 2126 N. University St., Peoria, IL 61604 | 2008-03-28 |
1821266123 | David L Krick | Dentist | 2022 N University, Peoria, IL 61604 | 2008-02-20 |
1568658409 | Advanced Physicians Health Care, S.c. | Chiropractor | 1200 West Loucks Ave, Peoria, IL 61604 | 2007-09-24 |
1902006000 | Noel Liu | Dentist | 3127 N. University St., Unit C, Peoria, IL 61604 | 2007-07-18 |
1568586386 | Susan B Bordenave-bishop | Dentist | 2116 N. Sheridan, Peoria, IL 61604 | 2007-03-19 |
1174689897 | Paul Anthony Amodeo | Dentist | 3100 N Dries Lane, Suite 301, Peoria, IL 61604 | 2006-12-28 |
Find all providers in zip 61604 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194343897 | Alyssa Kay Poland | Physician Assistant | 10006 W Los Gatos Dr, Peoria, AZ 85383-3343 | 2020-07-08 |
1871155143 | Terry Craven Wood | Physician Assistant | 7645 W Donald Dr, Peoria, AZ 85383-3142 | 2019-07-08 |
1174956031 | Kindal Alysse Sweet | Physician Assistant | 7677 W Paradise Ln Apt 1128, Peoria, AZ 85382-4974 | 2013-08-14 |
1831246669 | Joseph B Earl | Physician Assistant | 7615 W Thunderbird Rd Ste 105, Peoria, AZ 85381-6083 | 2007-01-04 |
1275612681 | James Anthony Caruso | Physician Assistant | 9601 North Lindbergh Dr, # 230, Peoria, IL 61615 | 2006-11-04 |
1922103407 | Brady Paul Nelson | Physician Assistant | 13943 N . 91st Ave Building I, Peoria, AZ 85381-3692 | 2006-09-13 |
1689786444 | Bruce A Ropte | Physician Assistant | 21731 N. 77th Avenue, Peoria, AZ 85382 | 2006-08-31 |
1265543391 | Elizabeth D Moore | Physician Assistant | 8940 N Wood Sage Road, Peoria, IL 61615 | 2006-08-31 |
1174500581 | Janis Suzann Forch | Physician Assistant | 7615 W Thunderbird Rd, Ste 106, Peoria, AZ 85381-6083 | 2005-12-28 |
1508858754 | Kenneth B Caton | Physician Assistant | 9165 W Thunderbird Rd, Ste 100, Peoria, AZ 85381 | 2005-08-15 |
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.