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General NPI Number Information
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NPI Number | 1083959167
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Entity Type | Individual
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Provider Name | JENNIFER LOUISE MIHAILOVIC APN
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Gender | Female
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Dates
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Enumeration Date | 11/30/2012
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 640 E NORTHWEST HWY STE 100
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-3307
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Country | US
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Telephone | 847-942-1406
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Fax |
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Provider Business Mailing Address
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Address Line | 515 DOVER DR
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City | DES PLAINES
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State | IL
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Zip | 60018-5545
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Country | US
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Telephone | 847-942-1406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277.000208
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License Number State | IL
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