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General NPI Number Information
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NPI Number | 1528056801
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Entity Type | Individual
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Provider Name | JENNIFER DEVANEY MD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 1170 E BELVIDERE RD STE 106
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2076
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Country | US
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Telephone | 847-548-7337
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Fax | 847-548-9909
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Provider Business Mailing Address
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Address Line | 1170 E BELVIDERE RD MUNDELEIN PEDIATRICS #106
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2061
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Country | US
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Telephone | 847-548-7337
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Fax | 847-548-9909
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 036101023
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License Number State | IL
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