Basic Information
| Provider Information | |||||||||
| NPI: | 1467624528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENSLEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 N RANDALL RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473818899 | ||||||||
| FaxNumber: | 8473818999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N RANDALL RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473818899 | ||||||||
| FaxNumber: | 8473818999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2008 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 036.148505 | IL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.