Healthcare Provider Details

I. General information

NPI: 1629730585
Provider Name (Legal Business Name): JENNIFER ADRIANNE INGRAM APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 E SCHILLER ST
ELMHURST IL
60126-2816
US

IV. Provider business mailing address

4201 WINFIELD RD
WARRENVILLE IL
60555-4025
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9001
  • Fax: 331-221-2305
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024307
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024307
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041342884
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: