| NPI | 1720421175 | 
|---|---|
| Former Name | JENNIFER SHINE MIDDENDORF | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2013009799) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209010646) | 
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209010646) | |
| 163W00000X Registered Nurse (Licence: MO 2004030088) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 209010646) | |
| Enumeration Date | 2013-04-15 | 
| Last Update Date | 2025-03-19 |