Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209011773 | IL |
NPI | 1003216557 |
---|---|
Provider Name | Mrs. Jennifer M Panning |
First Address | Chicago, IL 60643-1740 |
Second Address | Joliet, IL 60436-3172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2014 |
Last Update Date | 23/03/2017 |