Healthcare Provider Details

I. General information

NPI: 1114535135
Provider Name (Legal Business Name): JENANNE LUSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 W CERMAK RD
CHICAGO IL
60608-3514
US

IV. Provider business mailing address

2627 W CERMAK RD
CHICAGO IL
60608-3514
US

V. Phone/Fax

Practice location:
  • Phone: 773-389-3000
  • Fax: 773-389-3333
Mailing address:
  • Phone: 773-389-3000
  • Fax: 773-389-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277003637
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: