Organization
A WOMAN'S CONNECTION OF LASALLE-PERU P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH SUE JENNINGS-PORTER CNM (CNM-PRESIDENT)
(815) 220-0260
Entity
Organization
Contact information
Practice address
2220 MARQUETTE RD, PERU, IL 61354-1538
(815) 220-0260
(815) 220-8253
Mailing address
2220 MARQUETTE RD, PERU, IL 61354-1538
(815) 220-0260
(815) 220-8253
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05032022
BLUE CROSS BLUE SHIELD
IL
05
—
326404425001
—
IL
Enumeration date
05/01/2007
Last updated
04/02/2008
Update your record
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