Provider Demographics
NPI:1457716730
Name:NIEVES, JENNIFER C (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:NIEVES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE B301
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8439
Mailing Address - Country:US
Mailing Address - Phone:847-535-6083
Mailing Address - Fax:847-234-4336
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE B301
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8439
Practice Address - Country:US
Practice Address - Phone:847-535-6083
Practice Address - Fax:847-234-4336
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013566363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily