Ellens, Jennifer L

Ellens, Jennifer L is an individual health care provider with primary practice located at 444 N Park Blvd , Glen Ellyn IL 60137-4622. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Ellens, Jennifer L can be contacted via phone (630) 469-0045.

Contact Information

Primary practice address
444 N Park Blvd Glen Ellyn IL 60137-4622
Phone: (630) 469-0045
Fax: (630) 469-0645
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036103252 Illinois

Profile Details

NPI number 1912932831
LBN Legal business name Ellens, Jennifer L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Apr 4th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912932831 NPPES
Illinois Other 363149833 TAX IDENTIFICATION NUMBER
Illinois Other 487450 TAX IDENTIFICATION NUMBER
Illinois Other 0222075 TAX IDENTIFICATION NUMBER
Illinois MEDICAID 036103252 TAX IDENTIFICATION NUMBER
Illinois Other 080174264 TAX IDENTIFICATION NUMBER
Illinois Other 3631498336019001 TAX IDENTIFICATION NUMBER

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