Healthcare Provider Details

I. General information

NPI: 1144091489
Provider Name (Legal Business Name): PUNITHA JONADOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

V. Phone/Fax

Practice location:
  • Phone: 630-965-1579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209034140
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: