Healthcare Provider Details

I. General information

NPI: 1790712248
Provider Name (Legal Business Name): JENNIFER HALI ENOCH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W KENYON RD
CHAMPAIGN IL
61820-7807
US

IV. Provider business mailing address

201 W KENYON RD
CHAMPAIGN IL
61820-7807
US

V. Phone/Fax

Practice location:
  • Phone: 217-531-5365
  • Fax:
Mailing address:
  • Phone: 217-531-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209011795
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: