Provider Demographics
NPI:1790186955
Name:JENSEN, JENNIFER (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 TOWER CT
Mailing Address - Street 2:SUITE F
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5712
Mailing Address - Country:US
Mailing Address - Phone:847-360-8440
Mailing Address - Fax:847-360-8468
Practice Address - Street 1:1870 W WINCHESTER RD
Practice Address - Street 2:SUITE 241
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5358
Practice Address - Country:US
Practice Address - Phone:847-549-0170
Practice Address - Fax:847-549-0172
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily