Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 016005699 | IL |
N | 213EP1101X | Primary Podiatric Medicine | 107725 | WI |
NPI | 1407296171 |
---|---|
Provider Name | Dr. Jennifer E Bernstein |
First Address | Mount Prospect, IL 60056-6023 |
Second Address | Libertyville, IL 60048-5227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 28/12/2021 |