Healthcare Provider Details

I. General information

NPI: 1659831998
Provider Name (Legal Business Name): JENNA BIANCA BATARA DIONISIO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W HARLEM AVE
MONMOUTH IL
61462
US

IV. Provider business mailing address

1000 W HARLEM AVE
MONMOUTH IL
61462
US

V. Phone/Fax

Practice location:
  • Phone: 309-734-1414
  • Fax: 309-734-0323
Mailing address:
  • Phone: 309-734-1414
  • Fax: 309-734-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036172909
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: