Individual
AGNES A. FENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 FOUNDERS LN, JACKSONVILLE, IL 62650-3919
(217) 528-7541
(217) 527-3844
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209014954
IL
Other
Enumeration date
10/12/2016
Last updated
06/18/2020
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