Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 036.151925 | IL |
NPI | 1548624943 |
---|---|
Provider Name | Jennifer Bender Bakkensen |
First Address | Chicago, IL 60611-2908 |
Second Address | Chicago, IL 60611-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2016 |
Last Update Date | 23/06/2020 |