Healthcare Provider Details

I. General information

NPI: 1649623364
Provider Name (Legal Business Name): JENNIFER NOONAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16505 106TH CT
ORLAND PARK IL
60467-4522
US

IV. Provider business mailing address

16505 106TH CT
ORLAND PARK IL
60467-4522
US

V. Phone/Fax

Practice location:
  • Phone: 708-364-1550
  • Fax: 708-364-1468
Mailing address:
  • Phone: 708-364-1550
  • Fax: 708-364-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277005852
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: