Healthcare Provider Details

I. General information

NPI: 1255053724
Provider Name (Legal Business Name): JENNIFER BUENING APN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 WARRENVILLE RD STE 310
LISLE IL
60532-1348
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-545-7569
  • Fax: 630-432-6638
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209025956
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: