Provider Demographics
NPI:1548651490
Name:DEIBEL, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DEIBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N WILLIAM KUMPF BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605-2530
Mailing Address - Country:US
Mailing Address - Phone:309-676-0766
Mailing Address - Fax:309-676-5920
Practice Address - Street 1:719 N WILLIAM KUMPF BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2530
Practice Address - Country:US
Practice Address - Phone:309-676-0766
Practice Address - Fax:309-676-5920
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041306334163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse