Healthcare Provider Details

I. General information

NPI: 1457518474
Provider Name (Legal Business Name): JOY PERTILE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W HIGH ST
MORRIS IL
60450-1463
US

IV. Provider business mailing address

2000 SPRING RD SUITE 200
OAK BROOK IL
60523-1804
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-2932
  • Fax: 815-941-0486
Mailing address:
  • Phone: 630-472-8800
  • Fax: 630-472-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.006582
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: