Provider Demographics
NPI:1326068487
Name:WARREN, JENNIFER LEIGH (MSN, FNP, RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:WARREN
Suffix:
Gender:F
Credentials:MSN, FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N DAMEN AVE
Mailing Address - Street 2:UNIT #202
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5567
Mailing Address - Country:US
Mailing Address - Phone:773-278-1332
Mailing Address - Fax:
Practice Address - Street 1:1150 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-8160
Practice Address - Country:US
Practice Address - Phone:773-549-7757
Practice Address - Fax:773-549-1221
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily