Healthcare Provider Details

I. General information

NPI: 1285977595
Provider Name (Legal Business Name): JENNIFER MATSON WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 E NEW YORK ST
AURORA IL
60504-5160
US

IV. Provider business mailing address

18 S MICHIGAN AVE FLOOR 6
CHICAGO IL
60603-3200
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-0500
  • Fax: 630-585-5588
Mailing address:
  • Phone: 312-592-6800
  • Fax: 312-592-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209010344
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: