Provider Demographics
NPI:1043480874
Name:MURPHY, JEANELLE Y (DO)
Entity Type:Individual
Prefix:
First Name:JEANELLE
Middle Name:Y
Last Name:MURPHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JEANELLE
Other - Middle Name:Y
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-431-6330
Mailing Address - Fax:217-431-6350
Practice Address - Street 1:204 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:IL
Practice Address - Zip Code:61873-9355
Practice Address - Country:US
Practice Address - Phone:217-431-6330
Practice Address - Fax:217-431-6350
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123277207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A10134OtherSTATE LIC
IL036123277OtherSTATE LIC
IL036123277OtherSTATE LIC