Provider Demographics
NPI:1619416658
Name:HUSTON, JENNIFER (FNP-BC, APRN-FPA, CN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HUSTON
Suffix:
Gender:F
Credentials:FNP-BC, APRN-FPA, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E CONGRESS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6235
Mailing Address - Country:US
Mailing Address - Phone:815-477-0300
Mailing Address - Fax:815-477-0301
Practice Address - Street 1:107 S MCLEAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1822
Practice Address - Country:US
Practice Address - Phone:847-695-9900
Practice Address - Fax:847-695-9989
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000499363L00000X
IL277.000499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner