Provider Demographics
NPI:1679932057
Name:HOWARD, JENNIFER (RN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 IL RT 38
Mailing Address - Street 2:
Mailing Address - City:NACHUSA
Mailing Address - State:IL
Mailing Address - Zip Code:61057
Mailing Address - Country:US
Mailing Address - Phone:815-284-7796
Mailing Address - Fax:815-284-6162
Practice Address - Street 1:1515 W 9TH ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3312
Practice Address - Country:US
Practice Address - Phone:815-440-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.360563163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent