Healthcare Provider Details

I. General information

NPI: 1134585813
Provider Name (Legal Business Name): JENNIFER N WILLMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 N. ROUTE 91 STE 240
PEORIA IL
61615
US

IV. Provider business mailing address

8600 N RTE 91 SUITE 240
PEORIA IL
61615
US

V. Phone/Fax

Practice location:
  • Phone: 309-683-5457
  • Fax:
Mailing address:
  • Phone: 309-683-5095
  • Fax: 309-683-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277004274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: