Sunderland, Jennifer R

Sunderland, Jennifer R is an individual health care provider with primary practice located at 1750 E Lake Shore Dr Suite 110, Decatur IL 62521-3803. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Sunderland, Jennifer R can be contacted via phone (217) 464-1200.

Contact Information

Primary practice address
1750 E Lake Shore Dr Suite 110 Decatur IL 62521-3803
Phone: (217) 464-1200
Fax: (217) 464-1210
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 085003210 Illinois

Profile Details

NPI number 1659475655
LBN Legal business name Sunderland, Jennifer R
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 11th, 2006
Last updated Feb 6th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659475655 NPPES
Illinois Other 202735 MEDICARE PTAN LOCALITY 15
Illinois Other 215827 MEDICARE PTAN LOCALITY 15
Illinois Other 604530 MEDICARE PTAN LOCALITY 15

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