PATRESA R BRAGER (NPI# 1043236573) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043236573 |
| Entity Type | Individual |
| Full Name | PATRESA R BRAGER |
| Credential | PH.D. |
| Practice Address |
515 Ne Glen Oak Ave Peoria IL 61637-0001 |
| Mailing Address |
530 Ne Glen Oak Ave Peoria IL 61637-0001 |
| Practice Telephone | 3096556724 |
| Practice Fax Number | 3096554408 |
| Mailing Telephone | 3096552000 |
| Mailing Fax Number | 3096557869 |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE GROUP NO. | 207414 | 01 |
| Street Address |
515 NE GLEN OAK AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61637-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174596225 | University of Illinois | Pediatrics | 515 Ne Glen Oak Ave, Pediatric Neurology, Peoria, IL 61603-3165 | 2006-02-09 |
| 1528614484 | Jordan Mark Czajka | Physician Assistant | 515 Ne Glen Oak Ave, Peoria, IL 61603-3136 | 2019-08-15 |
| 1689061251 | Caleb Davis | Counselor | 515 Ne Glen Oak Ave, Suite 101, Peoria, IL 61603-3136 | 2015-04-22 |
| 1457770646 | Daniel M Couri Ltd | Internal Medicine | 515 Ne Glen Oak Ave, Suite 105, Peoria, IL 61603-3136 | 2014-04-15 |
| 1053658377 | Benjamin Joseph Richter | Clinical Neuropsychologist | 515 Ne Glen Oak Ave, Suite 101, Peoria, IL 61637-3167 | 2013-01-07 |
| 1457576688 | Robert A Pflederer | Internal Medicine | 515 Ne Glen Oak Ave, Suite 108, Peoria, IL 61603-3136 | 2007-04-14 |
| 1295704468 | Blas Zelaya | Pediatrics | 515 Ne Glen Oak Ave, Pediatric Neurology #308, Peoria, IL 61603-3165 | 2006-03-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
| Find all providers in zip 61637 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972139251 | Shirley Yang | Psychologist | 9165 W Thunderbird Rd Ste 201, Peoria, AZ 85381-4847 | 2020-03-18 |
| 1619523479 | Emma Kathryn Bucher | Psychologist | 6615 N. Big Hollow Rd, Peoria, IL 61615-2451 | 2019-08-16 |
| 1164076709 | Dawn C Roberts | Psychologist | 4307 W Rustic Hollow Dr, Peoria, IL 61615-2430 | 2019-07-31 |
| 1548624950 | David Francis Adams | Psychologist | 7617 N Villa Wood Ln Ste 1, Peoria, IL 61614-1595 | 2016-04-12 |
| 1780050476 | Kaysha Richards | Psychologist | 14050 N 83rd Ave Ste 290, Peoria, AZ 85381-5650 | 2015-08-17 |
| 1528453826 | Robert Mastikian | Psychologist | 16165 N 83rd Ave Ste 200, Peoria, AZ 85382-5816 | 2015-04-02 |
| 1891122636 | William Barker | Psychologist | 900 Main St Ste 780, Peoria, IL 61602-1067 | 2013-10-10 |
| 1922359629 | Ashurina Ream | Psychologist | 20403 N Lake Pleasant Rd # 117-134, Peoria, AZ 85382-9702 | 2012-09-21 |
| 1093907180 | Amy L Kaminski | Psychologist | 7747 W Deer Valley Rd, Suite 255, Peoria, AZ 85382-2117 | 2007-08-13 |
| 1346462850 | Advanced Behavioral Health P C | Psychologist | 8600 Route 91, North, Suite 240, Peoria, IL 61615 | 2007-05-03 |
| 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.