Provider Demographics
NPI:1700203593
Name:MAYER, JENNIFER ELIZABETH (RN, APN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:MAYER
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:HRUSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, APN
Mailing Address - Street 1:1718 W ROSCOE ST
Mailing Address - Street 2:APT. #2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1016
Mailing Address - Country:US
Mailing Address - Phone:816-582-6147
Mailing Address - Fax:
Practice Address - Street 1:1718 W ROSCOE ST
Practice Address - Street 2:APT. #2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1016
Practice Address - Country:US
Practice Address - Phone:816-582-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.364240163W00000X
IL209.011392363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse