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Individual

JAYNE K FEDOR

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
P.A.C.

Contact information

Practice address
751 N RUTLEDGE ST, SPRINGFIELD, IL 62702-4909
(217) 545-0173
(217) 788-5459
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7578
(217) 545-1884

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
IL

Other

Enumeration date
09/19/2005
Last updated
07/08/2007
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