Provider Demographics
NPI:1003102773
Name:HENRY, JILLIAN (MD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:RIGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:747 N RUTLEDGE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4964
Mailing Address - Country:US
Mailing Address - Phone:217-757-7932
Mailing Address - Fax:217-757-7920
Practice Address - Street 1:747 N RUTLEDGE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4964
Practice Address - Country:US
Practice Address - Phone:217-757-7932
Practice Address - Fax:217-757-7920
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036137824207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology