MEDICARE: JESSICA L DENNIS MSN, APRN, AGNP-BC

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	363LP2300X	Primary Care Nurse Practitioner	209.024352	IL
2	363L00000X	Nurse Practitioner	209024352	IL

General Provider Information

NPI Number	:	1447999511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA L DENNIS MSN, APRN, AGNP-BC

Provider Business Mailing Address
First Line	:	259 E ERIE ST STE 2120
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2987
Country	:	US
Telephone Number	:	312-695-8628
Fax Number	:	312-695-0114

Provider Business Practice Location Address
First Line	:	259 E ERIE ST STE 2120
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2987
Country	:	US
Telephone Number	:	312-695-8628
Fax Number	:	312-695-0114

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

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	06/03/2026

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