Individual
JENANNE LUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 W GREENLEAF AVE, CHICAGO, IL 60626-2805
(773) 432-6570
Mailing address
1400 W GREENLEAF AVE, CHICAGO, IL 60626-2805
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041495826
IL
163W00000X
Registered Nurse
RN281392
GA
363L00000X
Nurse Practitioner
Primary
209021527
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104979702
NCC
—
01
—
1859305
AANP
—
Enumeration date
07/15/2020
Last updated
05/02/2021
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