Provider Demographics
NPI:1326330135
Name:WELLER, JENNIFER MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:WELLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:DOERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2379 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4344
Mailing Address - Country:US
Mailing Address - Phone:309-429-7887
Mailing Address - Fax:
Practice Address - Street 1:2826 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-3354
Practice Address - Country:US
Practice Address - Phone:563-332-8528
Practice Address - Fax:563-445-8672
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2025-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP46329164W00000X
IL043.086635164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse