Healthcare Provider Details

I. General information

NPI: 1447999511
Provider Name (Legal Business Name): JESSICA L DENNIS MSN, APRN, AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 2120
CHICAGO IL
60611-2987
US

IV. Provider business mailing address

259 E ERIE ST STE 2120
CHICAGO IL
60611-2987
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8628
  • Fax: 312-695-0114
Mailing address:
  • Phone: 312-695-8628
  • Fax: 312-695-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024352
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.024352
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: