Individual
JEANNETTE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637
(309) 655-2000
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637
(502) 852-8696
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125080868
IL
208000000X
Pediatrics Physician
125080868
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/01/2020
Last updated
03/30/2026
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