Provider Demographics
NPI:1407043250
Name:WILLY, JENNY MAT-AN (RN)
Entity Type:Individual
Prefix:MISS
First Name:JENNY
Middle Name:MAT-AN
Last Name:WILLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9517 LAWLER AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1274
Mailing Address - Country:US
Mailing Address - Phone:630-544-4150
Mailing Address - Fax:
Practice Address - Street 1:9517 LAWLER AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1274
Practice Address - Country:US
Practice Address - Phone:630-544-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-333984163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse