Provider Demographics
NPI:1285121988
Name:PETERSON, JENNIFER LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2631 WILLIAMSBURG AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1111
Mailing Address - Country:US
Mailing Address - Phone:815-981-4742
Mailing Address - Fax:630-402-9169
Practice Address - Street 1:2631 WILLIAMSBURG AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1111
Practice Address - Country:US
Practice Address - Phone:815-981-4742
Practice Address - Fax:630-402-9169
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041369391163WG0000X
IL209.017872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice