Individual
JONATHAN EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1405 E 12TH ST, SUITE 600, MENDOTA, IL 61342-9010
(815) 538-7200
(815) 539-1444
Mailing address
1405 E 12TH ST, SUITE 600, MENDOTA, IL 61342-9010
(815) 538-7200
(815) 539-1444
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209012330
IL
Other
Enumeration date
12/19/2014
Last updated
12/19/2014
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