Provider Demographics
NPI:1568164432
Name:WIGNES, JILLIAN L (FNP-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:L
Last Name:WIGNES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CALUMET RD
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:61554-1413
Mailing Address - Country:US
Mailing Address - Phone:815-830-1755
Mailing Address - Fax:
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:IL
Practice Address - Zip Code:61561-7585
Practice Address - Country:US
Practice Address - Phone:815-830-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily