Provider Demographics
NPI:1144750894
Name:WARD, EMILY DENHAM
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DENHAM
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 N ALLEN RD # CONDOJ
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1573
Mailing Address - Country:US
Mailing Address - Phone:309-232-8535
Mailing Address - Fax:309-220-3783
Practice Address - Street 1:9010 N ALLEN RD # CONDOJ
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1573
Practice Address - Country:US
Practice Address - Phone:309-232-8535
Practice Address - Fax:309-220-3783
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant