Provider Demographics
NPI:1154333136
Name:CREECH, ALAN THOMAS (CNP, APN)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:THOMAS
Last Name:CREECH
Suffix:
Gender:M
Credentials:CNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5100
Mailing Address - Country:US
Mailing Address - Phone:217-554-3000
Mailing Address - Fax:217-554-4310
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-554-3000
Practice Address - Fax:217-554-4310
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ31785Medicare UPIN
ILK13043Medicare ID - Type Unspecified