Healthcare Provider Details

I. General information

NPI: 1093818072
Provider Name (Legal Business Name): ELIZABETH DILLMAN-JANCEK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 GLENWOOD AVE
JOLIET IL
60435-5676
US

IV. Provider business mailing address

8220 BEECH AVE
MUNSTER IN
46321-1405
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number28061859A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: