Healthcare Provider Details

I. General information

NPI: 1932952355
Provider Name (Legal Business Name): JENNIFER M BONNKE APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD STE 4900
SKOKIE IL
60076-5080
US

IV. Provider business mailing address

9650 GROSS POINT RD STE 4900
SKOKIE IL
60076-5080
US

V. Phone/Fax

Practice location:
  • Phone: 847-864-3278
  • Fax: 847-570-1865
Mailing address:
  • Phone: 847-864-3278
  • Fax: 847-570-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209029072
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: