Individual
JENNIFER K FOGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
4455 E US ROUTE 36, DECATUR, IL 62521-5003
(217) 876-5320
(217) 876-5865
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(217) 876-5320
(217) 876-5865
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016606
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209016606
APN LICENSE
IL
Enumeration date
10/27/2017
Last updated
09/05/2023
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