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General NPI Number Information
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NPI Number | 1184920084
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Entity Type | Individual
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Provider Name | KELLY ANN JASZAROWSKI RN, CWOCN
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Gender | Female
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 5409 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-5069
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Country | US
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Telephone | 309-683-6205
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Fax | 309-691-4543
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Provider Business Mailing Address
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Address Line | 5409 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-5069
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Country | US
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Telephone | 309-683-6205
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Fax | 309-691-4543
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 029.002704
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License Number State | IL
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