Healthcare Provider Details

I. General information

NPI: 1619495017
Provider Name (Legal Business Name): JEANINE M MURPHY APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANINE M GOODMAN

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

IV. Provider business mailing address

1804 N NAPER BLVD
NAPERVILLE IL
60563-8830
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6502
  • Fax:
Mailing address:
  • Phone: 630-646-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209016399
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: