Healthcare Provider Details

I. General information

NPI: 1700200870
Provider Name (Legal Business Name): JENNIFER LYNN CARPENTER APN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4500
  • Fax: 312-227-9636
Mailing address:
  • Phone: 312-942-6640
  • Fax: 312-942-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209011153
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: