MEDICARE: JESSICA DUMITRIU NP

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	363LW0102X	Women's Health Nurse Practitioner	209021645	IL

General Provider Information

NPI Number	:	1548875560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DUMITRIU NP

Provider Business Mailing Address
First Line	:	1449 N LARRABEE ST UNIT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-3262
Country	:	US
Telephone Number	:	847-406-0540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1147 S WABASH AVE STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2348
Country	:	US
Telephone Number	:	312-929-9191
Fax Number	:

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

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	09/16/2020

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