Healthcare Provider Details

I. General information

NPI: 1760386916
Provider Name (Legal Business Name): JORDAN A CLANTON ACNP-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CENTRAL RD
ARLINGTON HEIGHTS IL
60005-2349
US

IV. Provider business mailing address

24570 S INDEPENDENCE BLVD
CRETE IL
60417-2058
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041536951
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: