Provider Demographics
NPI:1285685388
Name:ALLEN, JENNIFER KRUSE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KRUSE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KRUSE
Other - Last Name:OFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:704 QUESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-1101
Mailing Address - Country:US
Mailing Address - Phone:217-357-0791
Mailing Address - Fax:
Practice Address - Street 1:704 QUESTOVER DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-1101
Practice Address - Country:US
Practice Address - Phone:217-357-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097277207Q00000X
MO111348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G62550Medicare UPIN