Healthcare Provider Details

I. General information

NPI: 1891290623
Provider Name (Legal Business Name): JENNIFER MANING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 730
CHICAGO IL
60611-2990
US

IV. Provider business mailing address

6001 TOSCANA DR APT 935
DAVIE FL
33314-3592
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0070
  • Fax:
Mailing address:
  • Phone: 305-877-6976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.157050
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: