Provider Demographics
NPI:1073843967
Name:WESSELMAN-WILLIAMS, JENNIFER D (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:WESSELMAN-WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2023 VADALABENE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5630
Mailing Address - Country:US
Mailing Address - Phone:618-288-7408
Mailing Address - Fax:618-288-7418
Practice Address - Street 1:2023 VADALABENE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5630
Practice Address - Country:US
Practice Address - Phone:618-288-7408
Practice Address - Fax:618-288-7418
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209007965363L00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology