Provider Demographics
NPI:1558441626
Name:BEVILLE, JENNIFER (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BEVILLE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SMETANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-0001
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:4900 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3611
Practice Address - Country:US
Practice Address - Phone:630-963-5440
Practice Address - Fax:630-963-5066
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP78200Medicare UPIN
ILK23491Medicare ID - Type Unspecified