Individual
DR. JESSICA HANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8818
(309) 624-8820
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8818
(309) 624-8820
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-121977
IL
208000000X
Pediatrics Physician
036-121977
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121977
—
IL
01
—
809840
MEDICARE GROUP PTAN
IL
Enumeration date
04/11/2007
Last updated
02/27/2009
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