Provider Demographics
NPI:1659446805
Name:REED, JANA (APN, ACNP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:APN, ACNP
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:
Other - Last Name:MANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:719 WM KUMPF BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605
Mailing Address - Country:US
Mailing Address - Phone:309-676-0766
Mailing Address - Fax:309-676-5920
Practice Address - Street 1:719 N WILLIAM KUMPF BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2530
Practice Address - Country:US
Practice Address - Phone:309-676-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004408363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner