Healthcare Provider Details

I. General information

NPI: 1457606121
Provider Name (Legal Business Name): JENNIFER G DZEMSKE APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER L GUENTHER APNP

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 FARGO AVE
SKOKIE IL
60077-3210
US

IV. Provider business mailing address

5454 FARGO AVE
SKOKIE IL
60077-3210
US

V. Phone/Fax

Practice location:
  • Phone: 847-221-6040
  • Fax: 847-213-2156
Mailing address:
  • Phone: 847-221-6040
  • Fax: 847-213-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13844
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number315608-31
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: