Provider Demographics
NPI:1396218202
Name:DEMSAR, JENNIFER ADELE (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ADELE
Last Name:DEMSAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N BORDERS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MARISSA
Mailing Address - State:IL
Mailing Address - Zip Code:62257-1195
Mailing Address - Country:US
Mailing Address - Phone:618-295-1591
Mailing Address - Fax:618-295-1473
Practice Address - Street 1:521 N BORDERS AVE STE C
Practice Address - Street 2:
Practice Address - City:MARISSA
Practice Address - State:IL
Practice Address - Zip Code:62257-1195
Practice Address - Country:US
Practice Address - Phone:618-443-1337
Practice Address - Fax:618-443-1383
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily