Healthcare Provider Details

I. General information

NPI: 1639813751
Provider Name (Legal Business Name): JEAN ALCASID YAO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TOWER CT STE C
GURNEE IL
60031-5711
US

IV. Provider business mailing address

PO BOX 7630
GURNEE IL
60031-7002
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-2960
  • Fax:
Mailing address:
  • Phone: 847-244-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024974
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: