Healthcare Provider Details

I. General information

NPI: 1316321060
Provider Name (Legal Business Name): JENNIFER B. HEARN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST 18TH FLOOR SUITE 250
CHICAGO IL
60611
US

IV. Provider business mailing address

675 NORTH SAINT CLAIR 18TH FLOOR SUITE 250
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8624
  • Fax: 312-695-6070
Mailing address:
  • Phone: 312-695-8624
  • Fax: 312-695-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.005531
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: