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General NPI Number Information
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NPI Number | 1457881682
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Entity Type | Individual
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Provider Name | JENNIFER J ROGULIC FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 600 S RANDALL RD
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City | ALGONQUIN
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State | IL
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Zip | 60102-5935
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Country | US
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Telephone | 224-783-4302
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Fax | 224-783-4356
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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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 | 209.016154
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.381690
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 171911-30
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License Number State | WI
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