Provider Demographics
NPI:1104253517
Name:LURGIO, JENNIFER MARIE (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:LURGIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6325 MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1357
Mailing Address - Country:US
Mailing Address - Phone:630-964-0506
Mailing Address - Fax:630-541-7485
Practice Address - Street 1:6325 MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1357
Practice Address - Country:US
Practice Address - Phone:630-964-0506
Practice Address - Fax:630-541-7485
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010673363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400113002Medicare PIN