MEDICARE: JENNIFER G DZEMSKE APNP

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	164W00000X	Licensed Practical Nurse	315608-31	WI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	13844	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457606121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER G DZEMSKE APNP

Provider Business Mailing Address
First Line	:	5454 FARGO AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3210
Country	:	US
Telephone Number	:	847-221-6040
Fax Number	:	847-213-2156

Provider Business Practice Location Address
First Line	:	5454 FARGO AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3210
Country	:	US
Telephone Number	:	847-221-6040
Fax Number	:	847-213-2156

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	12/11/2025

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