Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jenny Wagner

Individual provider Nurse Practitioner · NPI 1063885556

Jenny Wagner is a Nurse Practitioner in Peoria, Illinois. Qualified in 2014, 12 years ago. Practices with Osf Multi-Specialty Group, a 2,128-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
12
Licensed in
IL
In the registry since
2015

Practice location Address checks out

100 NE Randolph Ave
Peoria, IL 61606-1919
Phone: (309) 624-8500
Fax: (309) 624-8552
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 209.013545 (IL)

Record details

NPI number1063885556
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedNovember 5, 2015
Last updated in NPPESNovember 5, 2015
Mailing address100 Ne Randolph Ave, Peoria, IL 61606-1919

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Osf Multi-Specialty Group — 2128 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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