Healthcare Provider Details

I. General information

NPI: 1972609782
Provider Name (Legal Business Name): JENNIFER LYNN WEBB D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15730 ROBERT LOUIS DR
PLAINFIELD IL
60544-2146
US

IV. Provider business mailing address

15730 ROBERT LOUIS DR
PLAINFIELD IL
60544-2146
US

V. Phone/Fax

Practice location:
  • Phone: 815-577-9408
  • Fax:
Mailing address:
  • Phone: 815-577-9408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier61412WE
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerBCBSMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: