MEDICARE: JENNIFER WHITE AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	209017342	IL

General Provider Information

NPI Number	:	1083117071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WHITE AGACNP-BC

Provider Business Mailing Address
First Line	:	10201 S BELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10332 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-2411
Country	:	US
Telephone Number	:	708-476-2363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	06/28/2024

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