Individual provider · Type 1 NPI
Ethan Sperry
Family Nurse Practitioner · Peoria, IL
NPI number
1861371635
Active
Practice location
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Mailing address
203 Pine Cir
Eureka, IL 61530-1639
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | 209-033064 (IL) |
Family Nurse Practitioner: Definition to come...
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About NPI 1861371635
Ethan Sperry's National Provider Identifier is 1861371635, issued on Aug 27, 2025. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Peoria, IL. The record was last updated on Aug 27, 2025.