Provider Demographics
NPI:1942541149
Name:CELLA, JENNA M (DO)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:CELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:STEVANOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:395 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1222
Mailing Address - Country:US
Mailing Address - Phone:815-468-6870
Mailing Address - Fax:815-468-6864
Practice Address - Street 1:395 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1222
Practice Address - Country:US
Practice Address - Phone:815-468-6870
Practice Address - Fax:815-468-6864
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-139232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036139232Medicaid