Healthcare Provider Details

I. General information

NPI: 1700853496
Provider Name (Legal Business Name): JEANNE M OELERICH APRN FPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNE COCKRUM NP

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504
US

IV. Provider business mailing address

2000 OGDEN AVE
AURORA IL
60504-7222
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-6250
  • Fax:
Mailing address:
  • Phone: 630-978-6250
  • Fax: 630-978-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041300447
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number041-300447
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number277000260
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: