Provider Demographics
NPI:1427155886
Name:RAY, JANET (NP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W GARDEN ST.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605
Mailing Address - Country:US
Mailing Address - Phone:309-680-7600
Mailing Address - Fax:309-676-5506
Practice Address - Street 1:1005 NE JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4064
Practice Address - Country:US
Practice Address - Phone:309-680-7600
Practice Address - Fax:309-676-5506
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002041363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S73073Medicare UPIN