Individual
DR. JENNIFER ANNE LOETHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5 PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5621
(618) 876-2924
Mailing address
3165 MYRTLE AVE, GRANITE CITY, IL 62040-5012
(309) 648-6024
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036121965
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121965
—
IL
Enumeration date
06/08/2007
Last updated
06/22/2010
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