Healthcare Provider Details

I. General information

NPI: 1336854900
Provider Name (Legal Business Name): ERICA JEPSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 02/19/2023
Certification Date: 02/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 W ALGONQUIN RD STE 220
ARLINGTON HEIGHTS IL
60005-4423
US

IV. Provider business mailing address

2061 N SOUTHPORT AVE APT 328
CHICAGO IL
60614-6938
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-8899
  • Fax: 847-381-8999
Mailing address:
  • Phone: 815-701-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: