Individual
JENNIFER BOOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2400 N ROCKTON AVE, ROCKFORD, IL 61103-3655
(815) 971-5000
Mailing address
2400 N ROCKTON AVE, ROCKFORD, IL 61103-3655
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016612
IL
Other
Enumeration date
09/28/2017
Last updated
09/28/2017
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