Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 209009979 | IL |
NPI | 1013261361 |
---|---|
Provider Name | Mrs. Jenna T Winsko |
First Address | Crystal Lake, IL 60014-7978 |
Second Address | Crystal Lake, IL 60014-7978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2012 |
Last Update Date | 19/03/2021 |