Provider Demographics
NPI:1497206551
Name:MENENDEZ, JENNIFER VICTORIA (PA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:VICTORIA
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:611 W PARK
Mailing Address - Street 2:FAPC
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8195
Mailing Address - Country:US
Mailing Address - Phone:217-902-6954
Mailing Address - Fax:217-902-7711
Practice Address - Street 1:1302 FRANKLIN AVE STE 2800
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6526
Practice Address - Country:US
Practice Address - Phone:309-268-6300
Practice Address - Fax:309-268-6330
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2025-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
IL085005982363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant