Provider Demographics
NPI:1215116124
Name:EDWARDS, JENNIFER LYNN (CFA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NE GLEN OAK AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-4301
Mailing Address - Country:US
Mailing Address - Phone:309-672-5975
Mailing Address - Fax:309-655-1678
Practice Address - Street 1:120 NE GLEN OAK AVE STE 407
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4301
Practice Address - Country:US
Practice Address - Phone:309-672-5975
Practice Address - Fax:309-655-1678
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000175246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL106370OtherSURGICAL TECHNICIANS