Basic Information
| Provider Information | |||||||||
| NPI: | 1124344023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUBET | ||||||||
| FirstName: | JAMIE | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 MAIN ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616061907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3094950200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 MAIN ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616061907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3094950200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2010 | ||||||||
| LastUpdateDate: | 11/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041340647 | IL | N | Nursing Service Providers | Registered Nurse | 364S00000X | 209008156 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
No ID Information.