Healthcare Provider Details

I. General information

NPI: 1033148796
Provider Name (Legal Business Name): JENNIFER MARY DUFF APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARY DUFF APN

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POLK ST 1143
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

4521 N. MOZART STREET
CHICAGO IL
60625
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-4150
  • Fax: 312-864-9906
Mailing address:
  • Phone: 773-267-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-001911
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: