Healthcare Provider Details

I. General information

NPI: 1710387618
Provider Name (Legal Business Name): JACQUELINE RINCON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 S 1ST AVE RM 86B
MAYWOOD IL
60153-2307
US

IV. Provider business mailing address

807 S 1ST AVE RM 86B
MAYWOOD IL
60153-2307
US

V. Phone/Fax

Practice location:
  • Phone: 708-668-9067
  • Fax: 708-668-9067
Mailing address:
  • Phone: 708-668-9067
  • Fax: 708-668-9067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209012041
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: