Healthcare Provider Details

I. General information

NPI: 1154998342
Provider Name (Legal Business Name): JARRYD EDWARD MCGUIRE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/23/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W MAPLE ST
NEW LENOX IL
60451-1739
US

IV. Provider business mailing address

125 W MAPLE ST
NEW LENOX IL
60451-1739
US

V. Phone/Fax

Practice location:
  • Phone: 815-408-0988
  • Fax: 815-408-1081
Mailing address:
  • Phone: 815-408-0988
  • Fax: 815-408-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG167535
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277002764
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number167322
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.429974
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: