Healthcare Provider Details

I. General information

NPI: 1093106163
Provider Name (Legal Business Name): DARCY JURASKA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 GRANDVIEW AVE
GLEN ELLYN IL
60137-5579
US

IV. Provider business mailing address

248 GRANDVIEW AVE
GLEN ELLYN IL
60137-5579
US

V. Phone/Fax

Practice location:
  • Phone: 630-956-1530
  • Fax: 630-469-2552
Mailing address:
  • Phone: 630-956-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG141070
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.012344
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: