Provider Demographics
NPI:1033148796
Name:DUFF, JENNIFER MARY (APN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARY
Last Name:DUFF
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MARY
Other - Last Name:DUFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:4521 N. MOZART STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-267-8449
Mailing Address - Fax:
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:1143
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-4150
Practice Address - Fax:312-864-9906
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001911363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics