Individual
JESSICA LYNN BUGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
Mailing address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209018589
IL
363LP2300X
Primary Care Nurse Practitioner
209.018589
IL
Other
Enumeration date
01/24/2019
Last updated
07/07/2021
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