Provider Demographics
NPI:1740816065
Name:HACKMAN, JENNIE R (APN)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:R
Last Name:HACKMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24600 W. 127TH ST, BLDG B, STE # 340
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9507
Mailing Address - Country:US
Mailing Address - Phone:815-731-9100
Mailing Address - Fax:815-731-9110
Practice Address - Street 1:24600 W. 127TH ST, BLDG B, STE # 340
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9507
Practice Address - Country:US
Practice Address - Phone:815-731-9100
Practice Address - Fax:815-731-9110
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021030363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health