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General NPI Number Information
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NPI Number | 1982243036
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Entity Type | Individual
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Provider Name | JENNIFER CAROLYN MCANDREW PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 777 PARK AVE W
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2433
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Country | US
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Telephone | 847-432-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 757 PARK AVE W STE 2800
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2557
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Country | US
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Telephone | 847-432-1558
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.007374
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License Number State | IL
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