Provider Demographics
NPI:1467451781
Name:FEUCHT, JEANETTE MARIE (MSN CNP)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:FEUCHT
Suffix:
Gender:F
Credentials:MSN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:SUITE 220
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-585-0370
Practice Address - Fax:309-663-2956
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-303083163W00000X
IL018212363LF0000X
IL209-005113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00761350OtherRR MEDICARE INDIVIDUAL #
833120OtherMEDICARE GROUP #
CA2264OtherRR MEDICARE GROUP #
CA2264OtherRR MEDICARE GROUP #
CA2264OtherRR MEDICARE GROUP #
833120011Medicare PIN
P80708Medicare UPIN