Healthcare Provider Details

I. General information

NPI: 1144501479
Provider Name (Legal Business Name): JENNIFER E MORAVEC CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 HIGHLAND AVE
DOWNERS GROVE IL
60515-1500
US

IV. Provider business mailing address

225 7TH ST
DOWNERS GROVE IL
60515-5350
US

V. Phone/Fax

Practice location:
  • Phone: 630-971-0664
  • Fax:
Mailing address:
  • Phone: 630-971-0664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.306949
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209.008195
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: