Provider Demographics
NPI:1194807966
Name:SIENKOWSKI, JEANINE ELAINE (APN)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:ELAINE
Last Name:SIENKOWSKI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:ELAINE
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1441 BRANDING AVE STE 310
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5624
Practice Address - Country:US
Practice Address - Phone:630-829-1038
Practice Address - Fax:630-829-1040
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005498A363L00000X
IL277-000761363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01489127OtherRAILROAD MEDICARE
IN71005498AOtherLICENSE
ININ1241007Medicare PIN