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General NPI Number Information
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NPI Number | 1932665791
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Entity Type | Individual
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Provider Name | JENI LYNN ZOLFAGHARI APN, CNP
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Gender | Female
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Dates
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Enumeration Date | 02/18/2019
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 1603 TULLAMORE AVE STE A
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City | BLOOMINGTON
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State | IL
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Zip | 61704-9623
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Country | US
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Telephone | 309-808-6407
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Fax | 309-807-5478
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Provider Business Mailing Address
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Address Line | 133 SPINDER DR STE. 4015
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City | EAST PEORIA
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State | IL
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Zip | 61611-0016
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Country | US
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Telephone | 309-308-5100
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Fax | 309-308-5102
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209018441
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License Number State | IL
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