Provider Demographics
NPI:1972833416
Name:GIRARD, JACQUELINE TENOR (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:TENOR
Last Name:GIRARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WENONA
Mailing Address - State:IL
Mailing Address - Zip Code:61377-7514
Mailing Address - Country:US
Mailing Address - Phone:815-853-0014
Mailing Address - Fax:
Practice Address - Street 1:2500 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-9774
Practice Address - Country:US
Practice Address - Phone:815-842-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-291130163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine