Healthcare Provider Details

I. General information

NPI: 1164327375
Provider Name (Legal Business Name): DONNA JEAN WHITLEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 PROGRESS BLVD
PERU IL
61354-1109
US

IV. Provider business mailing address

1129 SARATOGA LN
STREATOR IL
61364-3602
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-9678
  • Fax: 708-202-5445
Mailing address:
  • Phone: 815-674-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043.055928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: