Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 209008111 | IL |
NPI | 1043536204 |
---|---|
Provider Name | Mrs. Jennifer L Besse |
First Address | Joliet, IL 60435-8200 |
Second Address | Joliet, IL 60435-8200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2010 |
Last Update Date | 06/09/2011 |