Provider Demographics
NPI:1306498571
Name:BEDNARZ, JENNIFER (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:BEDNARZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 W 167TH PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5720
Mailing Address - Country:US
Mailing Address - Phone:708-407-8663
Mailing Address - Fax:
Practice Address - Street 1:606 POTTER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5337
Practice Address - Country:US
Practice Address - Phone:800-570-8809
Practice Address - Fax:847-375-2101
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner