Individual
JANTZEN MICHELLE PRIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
815 MAIN ST STE C, PEORIA, IL 61602-1080
(309) 672-4977
Mailing address
815 MAIN ST STE C, PEORIA, IL 61602-1080
(309) 672-4977
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
90200000X
IL
Other
Enumeration date
04/10/2024
Last updated
04/10/2024
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