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BONITA G. DIETRICH
NPI 1386734689
Nurse Practitioner in Peoria, IL

Active since October 15, 2006
2900 N KNOXVILLE AVE, PEORIA, IL 61603(309) 688-3616(309) 687-3370 Get Directions Write a Review

NPPES record last updated: August 5, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Bonita G. Dietrich NPPES

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

BONITA G. DIETRICH (NPI 1386734689) is an individual nurse practitioner in Peoria, Illinois, licensed in Illinois (041248649/209000680) and active in the NPI registry since October 2006.

NPPES Registry Identity

NPI1386734689
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameBONITA G. DIETRICH
Location Address2900 N KNOXVILLE AVEPeoria, IL 61603-1748
Mailing Address2900 N Knoxville AvePeoria, IL 61603-1748 · (309) 688-3616 · Fax (309) 687-3370
Phone(309) 688-3616
Fax(309) 687-3370
Sole ProprietorNo
Enumeration DateOctober 15, 2006
Last NPPES UpdateAugust 5, 2009
✔ NPI 1386734689 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 · 041248649/209000680
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.
2900 N KNOXVILLE AVE, Peoria, IL 61603
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Other Identifiers 9

OtherCA4079Rr Group #
Medicare ID-Type Unspecified500005925IL · Rr Individual
Medicare UPINS67340
Medicare ID-Type Unspecified504850IL · Individual #
Medicare ID-Type UnspecifiedK36994IL · Individual # Eff 5-20-07
Medicare ID-Type Unspecified500005925 / CN1588IL · Rr
Medicare ID-Type Unspecified809840IL · Group # Eff 5-20-07
Other809840019IL · Medicare Individual Ptan
Medicare ID-Type UnspecifiedCN1588IL · Rr Group

Other Providers at the Same Location NPPES 4

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

TROY PEQUETTE
Pediatrics
2900 N KNOXVILLE AVE
PEORIA, IL 61603
Peoria County (309) 688-3616
JOHN GALBREATH
Pediatrics
2900 N KNOXVILLE AVE
PEORIA, IL 61603
Peoria County (309) 688-3616
ARLETA DEDIANOUS APRN
Pediatrics (Pediatric Allergy/Immunology)
2900 N KNOXVILLE AVE
PEORIA, IL 61603
Peoria County (309) 308-2000
JASON E. BECKER
Pediatrics
2900 N KNOXVILLE AVE
PEORIA, IL 61603
Peoria County (309) 688-3616

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bonita Dietrich's NPI number?

The NPI number for Bonita Dietrich is 1386734689. It was assigned to this individual provider in the NPPES registry on October 15, 2006.

Where is Bonita Dietrich located?

Bonita Dietrich practices at 2900 N Knoxville Ave, Peoria, IL 61603. The listed phone number is (309) 688-3616.

What is Bonita Dietrich's specialty?

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

When was this NPI record last updated?

The NPPES record for Bonita Dietrich was last updated on August 5, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.