Provider Demographics
NPI:1508325457
Name:BARNEWOLT, EMILY L (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:BARNEWOLT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 WINDMILL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-1224
Mailing Address - Country:US
Mailing Address - Phone:309-999-1090
Mailing Address - Fax:309-999-1094
Practice Address - Street 1:221 NE GLEN OAK AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61636-0001
Practice Address - Country:US
Practice Address - Phone:309-672-5500
Practice Address - Fax:309-672-4246
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-018701Other209-018701