Individual
JENNIFER MAYURI DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN, FNP
Contact information
Practice address
2050 PFINGSTEN RD STE 360, GLENVIEW, IL 60026-1313
(847) 998-4170
(847) 998-4165
Mailing address
2050 PFINGSTEN RD STE 360, GLENVIEW, IL 60026-1313
(847) 998-4170
(847) 998-4165
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.402891
IL
363L00000X
Nurse Practitioner
Primary
209016884
IL
363LF0000X
Family Nurse Practitioner
209.016884
IL
Other
Enumeration date
11/20/2017
Last updated
06/07/2021
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