Healthcare Provider Details

I. General information

NPI: 1366152019
Provider Name (Legal Business Name): JENNIFER LYNN HEFFERAN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN KEMPSTER

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 10/19/2023
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SETH PAINE SCHOOL 50 W. MILLER RD
LAKE ZURICH IL
60047
US

IV. Provider business mailing address

910 RICHARD BROWN BLVD
VOLO IL
60073
US

V. Phone/Fax

Practice location:
  • Phone: 847-540-4753
  • Fax: 847-438-2528
Mailing address:
  • Phone: 815-790-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041545191
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: