Healthcare Provider Details

I. General information

NPI: 1831055789
Provider Name (Legal Business Name): JINY M MOLLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JINY M MAGISTRADO

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 S MANISTEE AVE
BURNHAM IL
60633-2004
US

IV. Provider business mailing address

14500 S MANISTEE AVE
BURNHAM IL
60633-2004
US

V. Phone/Fax

Practice location:
  • Phone: 708-996-2737
  • Fax:
Mailing address:
  • Phone: 708-996-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209034695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: