Provider Demographics
NPI:1396521159
Name:MOY, JENNY (NP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:RUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9977 WOODS DR STE 165
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9977 WOODS DR STE 165
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:224-364-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041441989163W00000X
IL209029218363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209029218OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION