Healthcare Provider Details

I. General information

NPI: 1932665791
Provider Name (Legal Business Name): JENI LYNN ZOLFAGHARI APN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 TULLAMORE AVE STE A
BLOOMINGTON IL
61704-9623
US

IV. Provider business mailing address

133 SPINDER DR STE. 4015
EAST PEORIA IL
61611-0016
US

V. Phone/Fax

Practice location:
  • Phone: 309-808-6407
  • Fax: 309-807-5478
Mailing address:
  • Phone: 309-308-5100
  • Fax: 309-308-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209018441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: