MEDICARE: HYEJU JANG ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	209014349	IL
2	363LA2200X	Adult Health Nurse Practitioner	95003935	CA

General Provider Information

NPI Number	:	1659822443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYEJU JANG ANP-BC

Provider Business Mailing Address
First Line	:	12910 S SENECA RD
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2170
Country	:	US
Telephone Number	:	708-586-2530
Fax Number	:	708-448-5505

Provider Business Practice Location Address
First Line	:	12910 S SENECA RD
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2170
Country	:	US
Telephone Number	:	708-586-2530
Fax Number	:	708-448-5505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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