Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 125076810 | IL |
N | 207QA0505X | Family Doctor - Adult Medicine | 125.076810 | IL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 125.076810 | IL |
NPI | 1568099380 |
---|---|
Provider Name | Dr. Bianca Jenkins |
First Address | Chicago, IL 60647-5247 |
Second Address | Chicago, IL 60611-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2020 |
Last Update Date | 11/08/2021 |