Individual
SUZANNE JELLINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
526 W STATE ST, ROCKFORD, IL 61101-1214
(815) 968-9300
(815) 968-5314
Mailing address
1021 N MULFORD RD, ROCKFORD, IL 61107-3877
(815) 387-5600
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041-363672
IL
163W00000X
Registered Nurse
Primary
160574-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
96000668
ATHLETIC TRAINER
IL
Enumeration date
02/03/2012
Last updated
02/03/2012
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