Healthcare Provider Details

I. General information

NPI: 1578433256
Provider Name (Legal Business Name): PENNEY JO GAINER APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LAKE ZURICH RD
BARRINGTON IL
60010-3141
US

IV. Provider business mailing address

50 S MILWAUKEE AVE STE 103
LAKE VILLA IL
60046-9407
US

V. Phone/Fax

Practice location:
  • Phone: 844-656-8763
  • Fax:
Mailing address:
  • Phone: 224-215-6242
  • Fax: 224-842-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.033686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: