Provider Demographics
NPI:1033731500
Name:MISTRETTA, JESSICA N (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:MISTRETTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:N
Other - Last Name:ZEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 EDGAR ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1514
Mailing Address - Country:US
Mailing Address - Phone:573-808-3508
Mailing Address - Fax:
Practice Address - Street 1:8600 STATE ROUTE 91 STE 200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7833
Practice Address - Country:US
Practice Address - Phone:309-692-1030
Practice Address - Fax:309-691-3241
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036163468208000000X
IL125.076260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics