Healthcare Provider Details

I. General information

NPI: 1033007257
Provider Name (Legal Business Name): BRYN J JEMMI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 SALEM LAKE DR
LONG GROVE IL
60047-5292
US

IV. Provider business mailing address

3880 SALEM LAKE DR STE F
LONG GROVE IL
60047-5292
US

V. Phone/Fax

Practice location:
  • Phone: 847-719-2220
  • Fax:
Mailing address:
  • Phone: 847-719-2220
  • Fax: 847-719-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011298
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.011298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: