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General NPI Number Information
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NPI Number | 1760603294
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Entity Type | Organization
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Legal Business Name | A WOMAN'S CONNECTION OF LASALLE-PERU P.C.
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 2220 MARQUETTE RD
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City | PERU
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State | IL
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Zip | 61354-1538
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Country | US
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Telephone | 815-220-0260
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Fax | 815-220-8253
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Provider Business Mailing Address
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Address Line | 2220 MARQUETTE RD
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City | PERU
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State | IL
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Zip | 61354-1538
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Country | US
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Telephone | 815-220-0260
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Fax | 815-220-8253
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Authorized Official
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Title or Position | CNM-PRESIDENT
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Name | MRS. ELIZABETH SUE JENNINGS-PORTER
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Credential | CNM
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Telephone | 815-220-0260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State | IL
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