Individual
JENNIFER EDENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
351 DELNOR DR, GENEVA, IL 60134-4220
(630) 232-0280
(630) 232-3895
Mailing address
351 DELNOR DR, GENEVA, IL 60134-4220
(630) 232-0280
(630) 232-3895
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209001556
IL
363LA2100X
Acute Care Nurse Practitioner
209001556
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041263676
STATE LICENSE
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147100
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
MEDICARE RAILROAD PTAN (GROUP)
IL
01
—
P01093149
MEDICARE RAILROAD PTAN (INDIVIDUAL)
IL
Enumeration date
08/02/2006
Last updated
12/08/2012
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