Individual
JEANETTA FAHRNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5907 N ASPEN WOOD DR APT 5602, PEORIA, IL 61615-8433
(847) 345-5561
Mailing address
PO BOX 10752, PEORIA, IL 61612-0752
(847) 345-5561
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
01/27/2016
Last updated
12/07/2016
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