Healthcare Provider Details

I. General information

NPI: 1346905197
Provider Name (Legal Business Name): JENNIFER COMERFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MUSIL

II. Dates (important events)

Enumeration Date: 11/06/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 PARK AVE E
PRINCETON IL
61356-2537
US

IV. Provider business mailing address

709 W HUDSON ST
PRINCETON IL
61356-1183
US

V. Phone/Fax

Practice location:
  • Phone: 815-875-4531
  • Fax: 815-876-2218
Mailing address:
  • Phone: 815-876-6654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209021957
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021957
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: