Healthcare Provider Details

I. General information

NPI: 1659909372
Provider Name (Legal Business Name): JAELYN LOIS ANDERSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAELYN LOIS FRENCH

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E WALNUT ST STE A
WATSEKA IL
60970-1833
US

IV. Provider business mailing address

1490 E WALNUT ST STE A
WATSEKA IL
60970-1833
US

V. Phone/Fax

Practice location:
  • Phone: 815-432-7693
  • Fax: 815-936-7228
Mailing address:
  • Phone: 815-432-7693
  • Fax: 815-936-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021128
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71010380A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: