Individual
JENNIFER K BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
619 E MASON ST, SUITE 4P57, SPRINGFIELD, IL 62701-1034
(217) 788-0706
(217) 525-2535
Mailing address
PO BOX 19420, SPRINGFIELD, IL 62794-9420
(217) 788-0706
(217) 525-2535
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
209002373
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209002373
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
596500
RAILROAD
IL
Enumeration date
10/24/2006
Last updated
12/20/2021
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