TYLER VANDEROSTYNE (NPI# 1568013779) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1568013779 |
Entity Type | Individual |
Full Name | TYLER VANDEROSTYNE |
Practice Address |
815 Main St Peoria IL 61602-1076 |
Mailing Address |
1700 W Coneflower Dr Peoria IL 61615-1460 |
Practice Telephone | 3096724977 |
Enumeration Date | 2019-09-28 |
Last Update Date | 2020-01-22 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 163W00000X | Registered Nurse | 041.462539 | IL | Nursing Service Providers |
Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209.020739 | IL | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
815 MAIN ST |
City | PEORIA |
State | IL |
Zip Code | 61602-1076 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568082865 | Tolulope Oyebola Oke | Student in an Organized Health Care Education/Training Program | 815 Main St, Peoria, IL 61602-1076 | 2020-04-16 |
1184190613 | Shelby Laine Fehr | Registered Nurse | 815 Main St, Peoria, IL 61602-1076 | 2018-10-23 |
1457846834 | Serafino Sauro | Student in an Organized Health Care Education/Training Program | 815 Main St, Peoria, IL 61602-1076 | 2018-06-27 |
1457807646 | Emily Taylor | Nurse Practitioner | 815 Main St, Peoria, IL 61602-1076 | 2016-08-29 |
1356793459 | Omomengbe Oni | Family Medicine | 815 Main St, Peoria, IL 61602-1076 | 2016-07-13 |
1285085498 | Tauqeer Qazi | Family Medicine | 815 Main St, Ste A, Peoria, IL 61602-1076 | 2016-06-29 |
1245680651 | Thomas Joseph Bollaert | Family Medicine | 815 Main St, Peoria, IL 61602-1076 | 2016-06-16 |
1649629643 | Joseph Karas | Family Medicine | 815 Main St, Ste A, Peoria, IL 61602-1076 | 2016-06-09 |
1841649845 | Muhammad Deen | Family Medicine | 815 Main St, Ste A, Peoria, IL 61602-1076 | 2016-06-09 |
1245692730 | Fareedat Olwatosin Oluyadi | Family Medicine | 815 Main St, Peoria, IL 61602-1076 | 2016-03-23 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720574676 | Critical Care Rx, LLC | Pharmacy | 126 Oak St, Peoria, IL 61602 | 2018-07-03 |
1235675836 | Cheryl Beckman | Registered Nurse | 211 Fulton Street, Suite 207, One Technology Plaza, Peoria, IL 61602 | 2017-01-06 |
1063957942 | Rosemary Ince | Registered Nurse | 211 Fulton St. Suite 207, One Technology Plaza, Peoria, IL 61602 | 2016-12-30 |
1962674820 | Lisa Jean Burckhartzmeyer | Psychiatry & Neurology | 228 Ne Jefferson St, Peoria, IL 61602 | 2008-03-31 |
1669503587 | Jill Larson | Counselor | 330 Sw Washington Street, Peoria, IL 61602 | 2007-03-09 |
1265407399 | Cardiac Consultants Sc | Internal Medicine | 900 Main Street, Suite 320, Peoria, IL 61602 | 2006-02-22 |
1013364470 | Rafal Szymczuk | Student in an Organized Health Care Education/Training Program | 900 Main Street, Suite 720, Peoria, IL 61602 | 2016-05-16 |
1023422797 | Andrew Wang | Psychiatry & Neurology | 900 Main St Ste 580, Peoria, IL 61602 | 2014-06-20 |
1568805703 | Mohsina Ahmed | Psychiatry & Neurology | 900 Main St Ste 400, Peoria, IL 61602 | 2013-04-08 |
1750518775 | Laura Smith | Family Medicine | 815 Main St Ste A, Peoria, IL 61602 | 2009-06-17 |
Find all providers in zip 61602 |
Taxonomy Code | 363LF0000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Family |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1881295541 | Britney Julia Durst | Nurse Practitioner | 5905 N Prospect Rd, Peoria, IL 61614-4311 | 2020-11-07 |
1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
1699390039 | Steven Joel Schlink | Nurse Practitioner | 12920 W Roy Rogers Rd, Peoria, AZ 85383-5334 | 2020-06-11 |
1457986929 | Chanelle Christine Maclin | Nurse Practitioner | 504 E Kansas St, Peoria, IL 61603-2554 | 2020-03-05 |
1225677495 | Michelle Chacon | Nurse Practitioner | 23201 N 87th Dr, Peoria, AZ 85383-1860 | 2020-01-05 |
1689218042 | Patricia Nwakaego Ayemoba | Nurse Practitioner | 16018 N 74th Dr, Peoria, AZ 85382-1810 | 2019-10-29 |
1144877267 | Eunice Wright | Nurse Practitioner | 26826 N 85th Dr, Peoria, AZ 85383-3624 | 2019-08-22 |
1861057507 | Shawnee Renee Fudurich | Nurse Practitioner | 10230 W Happy Valley Pkwy Ste 100, Peoria, AZ 85383-4255 | 2019-05-08 |
1265096895 | Razel Espiritu Hernandez | Nurse Practitioner | 25435 N 115th Ave, Peoria, AZ 85383-9789 | 2019-04-29 |
1619435310 | Jennifer Gayle Ries-clark | Nurse Practitioner | 8009 W Salter Dr, Peoria, AZ 85382-4440 | 2019-03-12 |
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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.