Individual
MRS. JENNIFER K BARHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
1530 N RANDALL RD STE 210, ELGIN, IL 60123-7879
(224) 760-7322
(224) 535-8252
Mailing address
6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
(414) 858-4106
(414) 423-4134
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209-009597
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209009597
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147238
MEDICARE PTAN
IL
01
—
209-009597
LICENSE
IL
Enumeration date
06/21/2012
Last updated
10/05/2018
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