person
Marcus Ismedhi Mutidjo, APN
Family Nurse Practitioner in Peoria, Illinois
NPI 1063825446

Marcus Ismedhi Mutidjo is a Family Nurse Practitioner based in Peoria, IL and is specialized in Family. Marcus Ismedhi Mutidjo practices in Peoria, IL and has the professional credentials of APN. The NPI Number for Marcus Ismedhi Mutidjo is 1063825446 and holds a License No. 209016806 (Illinois).

The current practice location address for Marcus Ismedhi Mutidjo is 1701 W Garden St, Peoria, IL and can be reached out via phone at 309-680-7600 and via fax at 309-680-7686.

Location: 1701 W Garden St, Peoria, IL, 61604-3221
person
Provider Profile Details
NPI Number
1063825446
Provider Name
Marcus Ismedhi Mutidjo
Credential
APN
Provider Entity Type
Individual
Gender
Male
Address
1701 W Garden St, Peoria, IL, 61604-3221
Phone Number
309-680-7600
Fax Number
309-680-7686
Provider Enumeration Date
06/03/2014
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1701 W Garden St
City
State
Zip
61605
Phone Number
309-680-7600
Fax Number
309-680-7686
person
Provider Business Mailing Address Details
Address
1701 W Garden St
City
State
Zip
61605
Phone Number
309-680-7600
Fax Number
309-680-7686
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
License No.
209016806 (Illinois)
Definition
Definition to come...
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