Healthcare Provider Details

I. General information

NPI: 1306330642
Provider Name (Legal Business Name): JEFFREY S MITCHELL APN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-3000
  • Fax: 630-527-3581
Mailing address:
  • Phone: 847-570-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277002270
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: