Healthcare Provider Details

I. General information

NPI: 1427474709
Provider Name (Legal Business Name): JESSICA LYNN RINGWOOD FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LYNN KOPICKI FAMILY NURSE PRACTIT

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 N ASHLAND AVE
CHICAGO IL
60657-3012
US

IV. Provider business mailing address

3004 N ASHLAND AVE
CHICAGO IL
60657-3012
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-6624
  • Fax: 773-327-6685
Mailing address:
  • Phone: 773-327-6624
  • Fax: 773-327-6685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704279210
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010963
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: