Healthcare Provider Details

I. General information

NPI: 1144662388
Provider Name (Legal Business Name): JENNY M. DAAB PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 S RACE ST
URBANA IL
61801-4957
US

IV. Provider business mailing address

2905 N MAIN ST
DECATUR IL
62526-4274
US

V. Phone/Fax

Practice location:
  • Phone: 217-239-4220
  • Fax: 217-239-7396
Mailing address:
  • Phone: 217-877-9117
  • Fax: 217-877-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209010503
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: