Basic Information
| Provider Information | |||||||||
| NPI: | 1013306240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WUNDER | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 AMESBURY DR | ||||||||
| Address2: | |||||||||
| City: | SMITHVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640899625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022168249 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5025 N PAULINA ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732719040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2015 | ||||||||
| LastUpdateDate: | 06/14/2018 | ||||||||
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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 | 363LP0808X | 209012424 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.