Provider Demographics
NPI:1396492732
Name:WHITE, BRIANNA EDWARDS (APRN, CNP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:EDWARDS
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:EDWARDS
Other - Last Name:SIZEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNP
Mailing Address - Street 1:115 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2836
Mailing Address - Country:US
Mailing Address - Phone:309-256-9421
Mailing Address - Fax:
Practice Address - Street 1:5905 N PROSPECT RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4311
Practice Address - Country:US
Practice Address - Phone:309-308-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily