Healthcare Provider Details

I. General information

NPI: 1184898660
Provider Name (Legal Business Name): JENNIFER A. MISASI PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 N ASHLAND AVE
CHICAGO IL
60657-2127
US

IV. Provider business mailing address

3319 N ASHLAND AVE
CHICAGO IL
60657-2127
US

V. Phone/Fax

Practice location:
  • Phone: 773-747-8501
  • Fax:
Mailing address:
  • Phone: 773-747-8501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.005664
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: