Individual
MRS. ELIZABETH SUE JENNINGS-PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
2220 MARQUETTE RD, PERU, IL 61354-1538
(815) 220-0260
(815) 220-8253
Mailing address
2220 MARQUETTE RD, PERU, IL 61354-1538
(815) 220-0260
(815) 220-8253
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
209-000734
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05032022
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/01/2005
Last updated
07/08/2007
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