Mark Jennings
Neuromusculoskeletal Medicine (NMM)
Pediatric Neurology 515 Ne Glen Oak #308
Peoria
, Illinois 61603
Mark Jennings
Neuromusculoskeletal Medicine (NMM)
Pediatric Neurology 515 Ne Glen Oak #308
Peoria
, Illinois 61603
(309) 671-8503
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About
Features
Specialties
- Neuromusculoskeletal Medicine (NMM)
Languages spoken
- English
Location
First Address
- Mark Jennings
- 1 Illini Dr
- Peoria, IL
- Zip : 61605-2576
- Phone : (309) 671-8503
Second Address
- Mark Jennings
- Pediatric Neurology 515 Ne Glen Oak #308
- Peoria, IL
- Zip : 61603
- Phone : (309) 624-9844
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | IL |
National Provider Identifier
| NPI | 1356315246 |
|---|---|
| Provider Name | Mark Jennings |
| First Address | Peoria, IL 61605-2576 |
| Second Address | Peoria, IL 61603 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/02/2006 |
| Last Update Date | 09/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 07215036 | BCBS (01) | IL |
| A62840 | (02) | IL |
| IL01DP | JOHN DEERE (01) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.