=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306498571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER BEDNARZ APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2019
-----------------------------------------------------
Last Update Date | 07/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 606 POTTER RD
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60016-5337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-570-8809
-----------------------------------------------------
Fax | 847-375-2101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8610 W 167TH PL
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60462-5720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-407-8663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 209019312
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------