Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209007744 | IL |
NPI | 1063745404 |
---|---|
Provider Name | Mrs. Kimberly A. Cheek |
First Address | Peoria, IL 61603-1747 |
Second Address | Peoria, IL 61602-1060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2009 |
Last Update Date | 14/01/2020 |