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BONITA G. DIETRICH NPI 1386734689


NPI Information

NPI: 1386734689
Provider Name: BONITA G. DIETRICH
Classification: Nurse Practitioner - 363L00000X
Entity Type: Individual
Address:
2900 N KNOXVILLE AVE
PEORIA, IL
ZIP 61603
Phone: (309) 688-3616
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Bonita G. Dietrich is a nurse practitioner in Peoria, IL. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. Bonita G. Dietrich NPI is 1386734689. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2900 N KNOXVILLE AVE
PEORIA, IL
ZIP 61603-748
Phone: (309) 688-3616
Fax: (309) 687-3370

The enumeration date for this NPI number is 10/15/2006 and was last updated on 8/5/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363L00000XNurse Practitioner041248649/209000680ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1CA4079OTHERRR GROUP #
2500005925MEDICARE ID-TYPE UNSPECIFIEDILLINOISRR INDIVIDUAL
3S67340MEDICARE UPIN
4504850MEDICARE ID-TYPE UNSPECIFIEDILLINOISINDIVIDUAL #
5K36994MEDICARE ID-TYPE UNSPECIFIEDILLINOISINDIVIDUAL # EFF 5-20-07
6500005925 / CN1588MEDICARE ID-TYPE UNSPECIFIEDILLINOISRR
7809840MEDICARE ID-TYPE UNSPECIFIEDILLINOISGROUP # EFF 5-20-07
8809840019OTHERILLINOISMEDICARE INDIVIDUAL PTAN
9CN1588MEDICARE ID-TYPE UNSPECIFIEDILLINOISRR GROUP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.