Healthcare Provider Details

I. General information

NPI: 1912352089
Provider Name (Legal Business Name): JENNIFER L. DUNLOP APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S MAIN ST
LOMBARD IL
60148-2670
US

IV. Provider business mailing address

130 S MAIN ST
LOMBARD IL
60148-2670
US

V. Phone/Fax

Practice location:
  • Phone: 708-369-8053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041-339902
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277002559
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.014672
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041.339902
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: