MEDICARE: JENNIFER MATSON WHNP

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	363L00000X	Nurse Practitioner	209010344	IL

General Provider Information

NPI Number	:	1285977595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MATSON WHNP

Provider Business Mailing Address
First Line	:	18 S MICHIGAN AVE
Second Line	:	FLOOR 6
City	:	CHICAGO
State	:	IL
Zip	:	60603-3200
Country	:	US
Telephone Number	:	312-592-6800
Fax Number	:	312-592-6801

Provider Business Practice Location Address
First Line	:	3051 E NEW YORK ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-5160
Country	:	US
Telephone Number	:	630-585-0500
Fax Number	:	630-585-5588

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

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	04/04/2013

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