Doctor Name: | MS. JENNA SPAETH |
NPI Number: | 1669857512 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 085.005554 |
Business Practice Address: | 3880 Salem Lake Dr F Long Grove, IL - 600475292 |
Business Phone Number: | 8477192220 |
Business Fax Number: | 8477192265 |
Mailing Address: | 3880 Salem Lake Dr, F LONG GROVE |
State: | IL |
Postal Code: | 600475292 |
Phone Number: | 8477192220 |
Fax Number: | 8477192265 |
NPI Enumeration Date: | 07/21/2015 |
NPI Last Update Date: | 12/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 085.005554 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |