Healthcare Provider Details

I. General information

NPI: 1821321662
Provider Name (Legal Business Name): JENNIFER LYNN BROMELAND APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE STE 304
AURORA IL
60504-7205
US

IV. Provider business mailing address

2040 OGDEN AVE STE 304
AURORA IL
60504-7205
US

V. Phone/Fax

Practice location:
  • Phone: 630-898-3727
  • Fax: 630-499-2430
Mailing address:
  • Phone: 630-898-3727
  • Fax: 630-499-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209007766
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: