Healthcare Provider Details

I. General information

NPI: 1033628078
Provider Name (Legal Business Name): JINO BIJU JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

8123 W OAK AVE
NILES IL
60714-1722
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4235
  • Fax: 312-996-4235
Mailing address:
  • Phone: 224-628-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.015163
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: