Individual
JENNIFER WHITFILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 842-3633
(815) 844-6309
Mailing address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 842-3633
(815) 844-6309
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041-331318
IL
363L00000X
Nurse Practitioner
Primary
209-007683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
833230
MEDICARE GROUP #
IL
Enumeration date
06/08/2009
Last updated
10/13/2010
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