Bonita G. Dietrich

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

041248649/209000680 Issued in IL

Practice address

2900 N Knoxville Ave
Peoria, IL 61603-1748

Phone

(309) 688-3616

Fax

(309) 687-3370

NPI assigned

Oct 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249430400000",
    "number": "1386734689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616031748",
            "telephone_number": "309-688-3616",
            "fax_number": "309-687-3370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616031748",
            "telephone_number": "309-688-3616",
            "fax_number": "309-687-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "BONITA",
        "middle_name": "G.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-15",
        "last_updated": "2009-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "041248649/209000680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "809840019",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP #",
            "identifier": "CA4079",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia K. Dickinson
• Lauren Grey Didesch, PSY.D.
• Dalton Paul Dieckow, PHARMD
• Lane David Dieckow
• Lissa J Diefendorf, APN
• Cole J Dill, CRNA
• Dennis Wayne Dillard, C.PED., CTO
• Molly Dimler, PT, DPT, WCS
• Dzung Hong Dinh, MD
• Susannah Nicholson Dintzis, FNP

• Nurse Practitioner in Peoria, IL
• Providers in Peoria, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.