Individual
JAYNEE E PENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1345 EDWARDS ST STE 2, MORRIS, IL 60450-1692
(815) 942-1421
(815) 488-2033
Mailing address
725 SCHOOL ST STE A, MORRIS, IL 60450-1207
(815) 941-9124
(815) 941-4363
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036144109
IL
390200000X
Student in an Organized Health Care Education/Training Program
125066219
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.144109
IL LICENSE
IL
Enumeration date
06/08/2015
Last updated
10/09/2024
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