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General NPI Number Information
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NPI Number | 1245143999
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Entity Type | Individual
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Provider Name | JODENE L FUENTES BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 4461 PROGRESS BLVD
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City | PERU
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State | IL
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Zip | 61354-1109
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Country | US
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Telephone | 312-244-9902
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Fax | 708-202-5445
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Provider Business Mailing Address
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Address Line | 4461 PROGRESS BLVD
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City | PERU
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State | IL
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Zip | 61354-1109
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Country | US
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Telephone | 312-244-9902
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Fax | 708-202-5445
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 041368842
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License Number State | IL
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