Individual
JON NILES JESSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 522-3122
Mailing address
PO BOX 955277, SAINT LOUIS, MO 63195-5277
(217) 522-3122
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
036071861
IL
207P00000X
Emergency Medicine Physician
Primary
036071861
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360718611
—
IL
Enumeration date
02/10/2006
Last updated
04/29/2024
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