MEDICARE: JENNIFER HEIN

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	363LF0000X	Family Nurse Practitioner	209016908	IL

General Provider Information

NPI Number	:	1669068045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HEIN

Provider Business Mailing Address
First Line	:	11443 S CENTRAL PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3417
Country	:	US
Telephone Number	:	773-988-5143
Fax Number	:

Provider Business Practice Location Address
First Line	:	11443 S CENTRAL PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3417
Country	:	US
Telephone Number	:	773-988-5143
Fax Number	:

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

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	12/18/2020

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