Provider Demographics
NPI:1922336809
Name:GILL, JENNIFER L (CPNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GILL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GRODECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1460 N HALSTED ST STE 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2607
Mailing Address - Country:US
Mailing Address - Phone:312-279-8900
Mailing Address - Fax:
Practice Address - Street 1:1460 N HALSTED ST STE 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2607
Practice Address - Country:US
Practice Address - Phone:312-279-8900
Practice Address - Fax:312-981-6313
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007821363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics