Provider Demographics
NPI:1245304534
Name:JUNCK, JENNIFER MARIE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:JUNCK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 SYCAMORE RD
Mailing Address - Street 2:SUITE 1024
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9621
Mailing Address - Country:US
Mailing Address - Phone:815-752-3253
Mailing Address - Fax:815-752-3277
Practice Address - Street 1:3100 SYCAMORE RD
Practice Address - Street 2:SUITE 1024
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9621
Practice Address - Country:US
Practice Address - Phone:815-752-3253
Practice Address - Fax:815-752-3277
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20061649363LP0200X
IL209008728363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT01064Medicare PIN
MNQ72783Medicare UPIN