Healthcare Provider Details

I. General information

NPI: 1942049432
Provider Name (Legal Business Name): LIANNA JAESCHKE APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W RAND RD STE 110
ARLINGTON HTS IL
60004-2315
US

IV. Provider business mailing address

2650 RIDGE AVE. SUITE 1223
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-9292
  • Fax:
Mailing address:
  • Phone: 847-570-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041411051
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209030025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: