=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871583179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANINE HARSHBARGER FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2005
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 N WESTMORELAND RD # LEVEL1
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60045-1658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-535-7058
-----------------------------------------------------
Fax | 847-535-7023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 N WESTMORELAND RD # LEVEL1
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60045-1658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-535-7058
-----------------------------------------------------
Fax | 847-535-7023
-----------------------------------------------------
=====================================================
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 | 209000598
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 209-0000598
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------