Provider Demographics
NPI:1598037483
Name:JACOBS, PEGGY JO (RNC, CNM, DNP, APN)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:JO
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RNC, CNM, DNP, APN
Other - Prefix:
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Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:SUITE 181
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3592
Mailing Address - Country:US
Mailing Address - Phone:309-268-2640
Mailing Address - Fax:309-268-2649
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:SUITE 181
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3592
Practice Address - Country:US
Practice Address - Phone:309-268-2640
Practice Address - Fax:309-268-2649
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.002481367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife