MEDICARE: MS. JESSICA TAYLOR APN/CNS, CEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	209.015646	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209.015646	OTHER	IL	APN LICENSE NUMBER

General Provider Information

NPI Number	:	1033625025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA TAYLOR APN/CNS, CEN

Provider Business Mailing Address
First Line	:	44 W CENTER AVE
Second Line	:
City	:	LAKE BLUFF
State	:	IL
Zip	:	60044-2408
Country	:	US
Telephone Number	:	224-829-8798
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 W CENTER AVE
Second Line	:
City	:	LAKE BLUFF
State	:	IL
Zip	:	60044-2408
Country	:	US
Telephone Number	:	224-829-8798
Fax Number	:	224-829-8798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	06/16/2018

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