Provider Demographics
NPI:1295955284
Name:BINDER, JENNIFER LEE (CNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:BINDER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:2327 NEBRASKA RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108
Mailing Address - Country:US
Mailing Address - Phone:815-985-5254
Mailing Address - Fax:815-395-6455
Practice Address - Street 1:2327 NEBRASKA RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-7510
Practice Address - Country:US
Practice Address - Phone:815-985-5254
Practice Address - Fax:815-544-9966
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL156039363L00000X
IL209006581363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-273613OtherLICENSE
IL209-006581OtherADVANCED PRACTICE LICENSE