Healthcare Provider Details

I. General information

NPI: 1972072882
Provider Name (Legal Business Name): JENNIFER J COLLINS APN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WESTPORT CT
BLOOMINGTON IL
61704-8233
US

IV. Provider business mailing address

26141 E WILDLIFE DR
HOPEDALE IL
61747-9232
US

V. Phone/Fax

Practice location:
  • Phone: 309-722-4020
  • Fax: 309-740-4440
Mailing address:
  • Phone: 309-532-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number209.018406
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209018406
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: