MEDICARE: JACLYN NOTO CNM, APRN

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	2084P0800X	Psychiatry Physician	277002618	IL
2	367A00000X	Advanced Practice Midwife	277002618	IL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277002618	IL
4	176B00000X	Midwife	277002618	IL
5	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	209.019162	IL

General Provider Information

NPI Number	:	1912561267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN NOTO CNM, APRN

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-4625
Fax Number	:

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

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	02/19/2026

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