Provider Demographics
NPI:1215472329
Name:ANDERSON, JENNIFER C (NP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:C
Last Name:ANDERSON
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 1:3800 W 203RD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1185
Mailing Address - Country:US
Mailing Address - Phone:708-679-2233
Mailing Address - Fax:708-679-2231
Practice Address - Street 1:3800 W 203RD ST STE 202
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1185
Practice Address - Country:US
Practice Address - Phone:708-679-2233
Practice Address - Fax:708-679-2231
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000396363LF0000X
IL209015366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily