Provider Demographics
NPI:1538221858
Name:PETERS, MARILEE DALTON (NP)
Entity type:Individual
Prefix:MRS
First Name:MARILEE
Middle Name:DALTON
Last Name:PETERS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-2857
Mailing Address - Fax:217-876-2874
Practice Address - Street 1:241 W WEAVER RD
Practice Address - Street 2:SUITE 240
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-9762
Practice Address - Country:US
Practice Address - Phone:217-876-6350
Practice Address - Fax:217-876-6355
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL041-201711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner