Healthcare Provider Details

I. General information

NPI: 1578099800
Provider Name (Legal Business Name): JENNIFER MAZZULLI DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 816
CHICAGO IL
60602-3782
US

IV. Provider business mailing address

30 N MICHIGAN AVE STE 816
CHICAGO IL
60602-3782
US

V. Phone/Fax

Practice location:
  • Phone: 312-868-0700
  • Fax: 312-868-0740
Mailing address:
  • Phone: 312-868-0700
  • Fax: 312-868-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.389386
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.017056
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: