Healthcare Provider Details

I. General information

NPI: 1316343098
Provider Name (Legal Business Name): JAMIE ELIZABETH BLOECHL APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S GARY AVE STE 100
BLOOMINGDALE IL
60108-2200
US

IV. Provider business mailing address

245 S GARY AVE STE 100
BLOOMINGDALE IL
60108-2200
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4550
  • Fax: 630-933-2200
Mailing address:
  • Phone: 630-933-4550
  • Fax: 630-933-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.012099
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209012099
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: