Healthcare Provider Details

I. General information

NPI: 1659857886
Provider Name (Legal Business Name): JOSETTE JOVERO-CLODFELTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N EAST ST
OLNEY IL
62450-2432
US

IV. Provider business mailing address

800 E LOCUST ST
OLNEY IL
62450-2553
US

V. Phone/Fax

Practice location:
  • Phone: 618-392-2940
  • Fax: 618-392-7225
Mailing address:
  • Phone: 618-395-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008098A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209019979
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: