1366152019 NPI number — MS. JENNIFER LYNN HEFFERAN LPN

Table of content: MS. JENNIFER LYNN HEFFERAN LPN (NPI 1366152019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366152019 NPI number — MS. JENNIFER LYNN HEFFERAN LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEFFERAN
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEMPSTER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366152019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 RICHARD BROWN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOLO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-790-8900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SETH PAINE SCHOOL
Provider Second Line Business Practice Location Address:
50 W. MILLER RD
Provider Business Practice Location Address City Name:
LAKE ZURICH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-540-4753
Provider Business Practice Location Address Fax Number:
847-438-2528
Provider Enumeration Date:
12/02/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  041545191 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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