Healthcare Provider Details

I. General information

NPI: 1467451781
Provider Name (Legal Business Name): JEANETTE MARIE FEUCHT MSN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR SUITE 220
BLOOMINGTON IL
61701
US

IV. Provider business mailing address

611 W. PARK ST. FAPC
URBANA IL
61801
US

V. Phone/Fax

Practice location:
  • Phone: 309-585-0370
  • Fax: 309-663-2956
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number018212
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-005113
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: