Healthcare Provider Details

I. General information

NPI: 1700719457
Provider Name (Legal Business Name): JORDANNE TWIGG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 HIGHWAY 164 E
OQUAWKA IL
61469-3204
US

IV. Provider business mailing address

1709 S 9TH AVE
ELDRIDGE IA
52748-1802
US

V. Phone/Fax

Practice location:
  • Phone: 309-924-2414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037121
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: