Provider Demographics
NPI:1376892398
Name:DOLE, JENNIFER LYNN (APRN, CCNS-BC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DOLE
Suffix:
Gender:F
Credentials:APRN, CCNS-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:CURBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N WALL ST STE C100
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2942
Mailing Address - Country:US
Mailing Address - Phone:815-933-4400
Mailing Address - Fax:815-933-9646
Practice Address - Street 1:500 N WALL ST STE C100
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2942
Practice Address - Country:US
Practice Address - Phone:815-933-4400
Practice Address - Fax:815-933-9646
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009944364SC0200X, 364SC0200X
IL041.348114163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse