Individual
JENNIFER MICHELLE MAZANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1003 E MCCORD ST, CENTRALIA, IL 62801-3345
(618) 436-6633
Mailing address
1003 E MCCORD ST, CENTRALIA, IL 62801-3345
(618) 436-6633
(618) 436-6633
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209035018
IL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
2026002351
IL
Other
Enumeration date
02/17/2026
Last updated
05/05/2026
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