Healthcare Provider Details

I. General information

NPI: 1346521770
Provider Name (Legal Business Name): JAYME L SIBLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N ASHLAND AVE
CHICAGO IL
60614-2021
US

IV. Provider business mailing address

2400 N ASHLAND AVE
CHICAGO IL
60614-2021
US

V. Phone/Fax

Practice location:
  • Phone: 773-270-5600
  • Fax: 773-360-7378
Mailing address:
  • Phone: 773-270-5600
  • Fax: 773-360-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-003842
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.003842
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: