Provider Demographics
NPI:1700998622
Name:STEFFEN, JENNY H (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:H
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:H
Other - Last Name:MASUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 EAST LOCUST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60921
Mailing Address - Country:US
Mailing Address - Phone:815-635-3177
Mailing Address - Fax:815-635-3008
Practice Address - Street 1:1701 E. COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-664-3170
Practice Address - Fax:309-664-3149
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL833230Medicare ID - Type UnspecifiedGROUP #
ILQ71798Medicare UPIN
ILK37874Medicare ID - Type UnspecifiedINDIVIDUAL #