Healthcare Provider Details

I. General information

NPI: 1801563986
Provider Name (Legal Business Name): JANEL M DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE STE 1200
PEORIA IL
61637-0001
US

IV. Provider business mailing address

530 NE GLEN OAK AVE STE 1200
PEORIA IL
61637-0001
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-7811
  • Fax: 309-624-7734
Mailing address:
  • Phone: 309-624-7811
  • Fax: 309-624-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209022812
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022812
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: