Healthcare Provider Details

I. General information

NPI: 1376892398
Provider Name (Legal Business Name): JENNIFER LYNN DOLE APRN, CCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN CURBY

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N WALL ST STE C100
KANKAKEE IL
60901-2942
US

IV. Provider business mailing address

500 N WALL ST STE C100
KANKAKEE IL
60901-2942
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-4400
  • Fax: 815-933-9646
Mailing address:
  • Phone: 815-933-4400
  • Fax: 815-933-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number209.009944
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.348114
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: