Individual provider · Type 1 NPI

Jenna Dively, FNP-C

Family Nurse Practitioner · Canton, IL

NPI number 1508747387 Active

Practice location

210 W Walnut St
Canton, IL 61520-2497

Mailing address

1133 Woodland Trl
Macomb, IL 61455-3522

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner Primary 363LF0000X209.033183 (IL)

Family Nurse Practitioner: Definition to come...

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About NPI 1508747387

Jenna Dively, FNP-C's National Provider Identifier is 1508747387, issued on Sep 9, 2025. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Canton, IL. The record was last updated on Sep 9, 2025.