Healthcare Provider Details

I. General information

NPI: 1467858514
Provider Name (Legal Business Name): JENNIFER L RIMAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N RUTLEDGE ST STE 1100
SPRINGFIELD IL
62702-4968
US

IV. Provider business mailing address

PO BOX 19628
SPRINGFIELD IL
62794-9628
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-4735
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209012195
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: