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General NPI Number Information
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NPI Number | 1477006294
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Entity Type | Individual
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Provider Name | JANELLE KLOCH APN
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Gender | Female
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 9951 ROCK CUT XING
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City | LOVES PARK
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State | IL
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Zip | 61111-1999
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Country | US
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Telephone | 815-639-8500
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Fax | 815-639-8501
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Provider Business Mailing Address
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Address Line | 681 BRIGHTON CIR
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City | PINGREE GROVE
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State | IL
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Zip | 60140-2100
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Country | US
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Telephone | 630-337-4713
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209014610
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License Number State | IL
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