Healthcare Provider Details

I. General information

NPI: 1750833042
Provider Name (Legal Business Name): JENNIFER MOKOS BS, EDM, CFCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LINCOLNSHIRE DR
CHAMPAIGN IL
61821-5608
US

IV. Provider business mailing address

1010 LINCOLNSHIRE DR
CHAMPAIGN IL
61821-5608
US

V. Phone/Fax

Practice location:
  • Phone: 217-480-7719
  • Fax:
Mailing address:
  • Phone: 217-480-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: