Doctor Name: | JEZZICA UY |
NPI Number: | 1265806244 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 209013227 |
Business Practice Address: | 530 Randall Rd South Elgin, IL - 601773315 |
Business Phone Number: | 3123991169 |
Business Fax Number: | |
Mailing Address: | 2954 N Major Ave, CHICAGO |
State: | IL |
Postal Code: | 606345224 |
Phone Number: | 3123991169 |
Fax Number: | |
NPI Enumeration Date: | 11/14/2015 |
NPI Last Update Date: | 05/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209013227 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |