Healthcare Provider Details

I. General information

NPI: 1811657323
Provider Name (Legal Business Name): JESSICA LYNN NOWAKOWSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA CURRAN

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9608 S ROBERTS RD
HICKORY HILLS IL
60457-2238
US

IV. Provider business mailing address

9608 S ROBERTS RD
HICKORY HILLS IL
60457-2238
US

V. Phone/Fax

Practice location:
  • Phone: 708-233-5333
  • Fax:
Mailing address:
  • Phone: 708-233-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: