Individual
JENNA DIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
210 W WALNUT ST, CANTON, IL 61520-2497
(309) 647-0201
Mailing address
1133 WOODLAND TRL, MACOMB, IL 61455-3522
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.033183
IL
Other
Enumeration date
09/09/2025
Last updated
09/09/2025
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