Provider Demographics
NPI:1710138508
Name:EETEN, ALISON B (CNP)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:B
Last Name:EETEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 N. KNOXVILLE AVE.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603
Mailing Address - Country:US
Mailing Address - Phone:309-688-7010
Mailing Address - Fax:309-688-7044
Practice Address - Street 1:2901 N. KNOXVILLE AVE.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603
Practice Address - Country:US
Practice Address - Phone:309-688-7010
Practice Address - Fax:309-688-7044
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007286363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology