Basic Information
| Provider Information | |||||||||
| NPI: | 1063817013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNIEGOWSKI | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 676 N SAINT CLAIR ST STE 2125 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950990 | ||||||||
| FaxNumber: | 3126953098 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 N SAINT CLAIR ST FL 21 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950990 | ||||||||
| FaxNumber: | 3126953098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 085-005154 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.