Provider Demographics
NPI:1053383471
Name:NALL, BARBARA J (APN)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:NALL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 N KNOXVILLE AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5098
Mailing Address - Country:US
Mailing Address - Phone:309-692-5100
Mailing Address - Fax:309-692-1400
Practice Address - Street 1:5401 N KNOXVILLE AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5098
Practice Address - Country:US
Practice Address - Phone:309-692-5100
Practice Address - Fax:309-692-1400
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002307363LW0102X
IL209002307363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNAL1-0428-3835OtherCERT OF WHC NP
IL041-180296OtherRN LICENSE
IL209-002307OtherAPN LICENSE
ILL78030Medicare ID - Type UnspecifiedMEMBER #