Healthcare Provider Details

I. General information

NPI: 1720760705
Provider Name (Legal Business Name): JESSICA VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

201 GRAYS DR
OSWEGO IL
60543-7343
US

V. Phone/Fax

Practice location:
  • Phone: 312-947-1400
  • Fax:
Mailing address:
  • Phone: 630-999-7542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number041.455786
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: