Tracey Ann Antle, C.N.M
Individual provider Active NPI Advanced Practice Midwife · Peru, IL
NPI 1598981193 · NPPES record last updated Jul 26, 2011
Key facts
- NPI
- 1598981193
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Advanced Practice Midwife 367A00000X
- License
- 209-0043370 (IL)
- Practice address
- 920 West St
BLDG B
Peru, IL 61354-2763 - Phone
- (815) 223-2944
- Fax
- (815) 223-4095
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209-0043370 | IL | MD | Advanced Practice Midwife |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 209-0043370 | IL | Yes |
Addresses
Primary practice location
920 West St
BLDG B
Peru, IL 61354-2763
Mailing address
1305 6TH St
Peru, IL 61354-2759
Phone (815) 780-5029
Other providers in Peru, IL
- Allure of Peru, LLC
- Alpha Dental Care
- Noor Alshaikh
- Rene Marie Anderes
- Andreoni & Co
- Apex Medical PC
- Haleigh Catherine Augspols
- Austriaco Dental Associates - Peru LLC
- Juli Baker
- Emily Balestri
All providers in Peru, IL · Advanced Practice Midwife in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.