Healthcare Provider Details

I. General information

NPI: 1396218202
Provider Name (Legal Business Name): JENNIFER ADELE DEMSAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S BURNS AVE
SPARTA IL
62286-1894
US

IV. Provider business mailing address

215 S BURNS AVE
SPARTA IL
62286-1894
US

V. Phone/Fax

Practice location:
  • Phone: 618-443-4889
  • Fax: 618-443-1344
Mailing address:
  • Phone: 618-443-4889
  • Fax: 618-443-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018216
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: