Individual
DR. JACOB DANIEL WENGERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, FNP
Contact information
Practice address
9515 HOLY CROSS LN STE 175, BREESE, IL 62230-3618
(618) 526-8430
Mailing address
9515 HOLY CROSS LN STE 175, BREESE, IL 62230-3618
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209023063
IL
363LF0000X
Family Nurse Practitioner
209023063
IL
Other
Enumeration date
01/27/2014
Last updated
10/03/2023
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