Individual
DONNA J BRENENSTALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
5401 N KNOXVILLE AVE STE 114, PEORIA, IL 61614-5091
(309) 689-8477
(309) 683-0201
Mailing address
5401 N KNOXVILLE AVE STE 114, PEORIA, IL 61614-5091
(309) 689-8477
(309) 683-0201
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209001128
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041149492
RN
—
01
—
209001128
APN
—
01
—
309001107
CONT SUBS
—
Enumeration date
03/29/2006
Last updated
03/07/2023
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