EDWARD E ETHERTON NP
NPI 1053662783
Nurse Practitioner in Peoria, IL

Q: What is Edward Etherton's NPI number?

The NPI number for Edward Etherton is 1053662783. It was assigned to this individual provider in the NPPES registry on September 20, 2012.

Q: What is Edward Etherton's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Edward Etherton was last updated on November 18, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 20, 2012

1701 W GARDEN ST, PEORIA, IL 61605(309) 680-7600(309) 680-7637 Get Directions Write a Review

NPPES record last updated: November 18, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Edward E Etherton Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDWARD E ETHERTON NP (NPI 1053662783) is an individual nurse practitioner in Peoria, Illinois, licensed in Illinois (209-009512) and active in the NPI registry since September 2012.

NPPES Registry Identity

NPI1053662783

Entity TypeIndividualMale

Primary Taxonomy363L00000X

Provider Legal NameEDWARD E ETHERTONCredential: NP

Location Address1701 W GARDEN STPeoria, IL 61605-3531

Mailing Address1701 W Garden StPeoria, IL 61605-3531 · (309) 680-7600 · Fax (309) 680-7686

Phone(309) 680-7600

Fax(309) 680-7637

Sole ProprietorNo

Enumeration DateSeptember 20, 2012

Last NPPES UpdateNovember 18, 2013

✔ NPI 1053662783 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in IL · 209-009512

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

1701 W GARDEN ST, Peoria, IL 61605

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Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SARAH R KOSCICA MD

Family Medicine