Jennifer Renee Stoller, DNP, PNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209.025987 Issued in IL

Practice address

401 N Main St
Roanoke, IL 61561-7585

Phone

(309) 923-2661

NPI assigned

Jan 6, 2023

Last updated

Jan 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Cardinal Medical Group, LTD.

  • Multi-Specialty Clinic/Center
  • Peoria, IL
  • NPI 1992829485
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1154035913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 MACALLEN LAKE RD",
            "city": "CARLOCK",
            "state": "IL",
            "postal_code": "617259032",
            "telephone_number": "309-657-7918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N MAIN ST",
            "city": "ROANOKE",
            "state": "IL",
            "postal_code": "615617585",
            "telephone_number": "309-923-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLLER",
        "first_name": "JENNIFER",
        "middle_name": "RENEE",
        "credential": "DNP, PNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-06",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209.025987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roanoke RX LLC (Axline Pharmacy 03)
• Marsha Alexandra Rodriguez, APRN
• Saint James Hospital (OSF Healthcare - Medical Group - Roanoke)
• Michelle M Stephens, APN
• Brad A. Stoecker, MD
• Erica Nicole Svendsen, APRN,CNP
• Victory Home Care Services, Inc.
• Tracy Jo Walker
• Jillian L Wignes, FNP-C
• Casey David Williams, FNP

• Pediatric Nurse Practitioner in Roanoke, IL
• Providers in Roanoke, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.