Healthcare Provider Details

I. General information

NPI: 1447184692
Provider Name (Legal Business Name): JOSIE JONES BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

11018 N JASON DR
DUNLAP IL
61525-9695
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-1261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041.449511
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: