Healthcare Provider Details

I. General information

NPI: 1740816065
Provider Name (Legal Business Name): JENNIE R HACKMAN APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W. 127TH ST, BLDG B, STE # 340
PLAINFIELD IL
60585-9507
US

IV. Provider business mailing address

24600 W. 127TH ST, BLDG B, STE # 340
PLAINFIELD IL
60585-9507
US

V. Phone/Fax

Practice location:
  • Phone: 815-731-9100
  • Fax: 815-731-9110
Mailing address:
  • Phone: 815-731-9100
  • Fax: 815-731-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209021030
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.021030
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: