MRS. LISSA J DIEFENDORF


Address: 403 W Corrington Ave, Peoria, IL 61604-2803
Phone: 3092225736

MRS. LISSA J DIEFENDORF (NPI# 1427356336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1427356336
Entity Type Individual
Full Name MRS. LISSA J DIEFENDORF
Credential APN
Practice Address 403 W Corrington Ave
Peoria
IL 61604-2803
Practice Telephone 3092225736
Mailing Telephone 3092225736
Enumeration Date 2011-03-02
Last Update Date 2011-03-02
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 364SA2200X Clinical Nurse Specialist
Specialization: Adult Health
209008169 IL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 403 W CORRINGTON AVE
City PEORIA
State IL
Zip Code 61604-2803

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Taxonomy Information

Taxonomy Code 364SA2200X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Clinical Nurse Specialist
Specialization Adult Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1528351962 Kristi Kae Williams Clinical Nurse Specialist 530 Ne Glenoak Avenue Pob Suite 108, Peoria, IL 61603-3117 2011-05-18
1356792956 Jessica Gamblin Clinical Nurse Specialist 8940 N Wood Sage Rd, Peoria, IL 61615-7822 2016-06-24
1285045013 Melinda Lucille Lange Clinical Nurse Specialist 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2014-05-14
1679904858 William Meyers II Clinical Nurse Specialist 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2013-12-12
1609211101 Ruth Ann Arms Clinical Nurse Specialist 530 Ne Glen Oak Ave, Peoria, IL 61637-1726 2013-05-09
1902152077 Linda Marie Cooper Clinical Nurse Specialist 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2012-07-26
1871865683 Sarah L Lindsey Clinical Nurse Specialist 8940 N Wood Sage Rd, Peoria, IL 61615-7822 2012-02-09
1104103670 Jessica M Stewart Clinical Nurse Specialist 8940 N Wood Sage Rd, Peoria, IL 61615-7822 2011-11-10
1124304407 Melissa R Mcqueary Clinical Nurse Specialist 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2011-10-31
1598048456 Laura A Youngman Clinical Nurse Specialist 2265 W Altorfer Dr, Peoria, IL 61615-1807 2011-09-27
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Competitor

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City PEORIA
Zip Code 61604

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Dataset Information

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.

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