Healthcare Provider Details

I. General information

NPI: 1548552599
Provider Name (Legal Business Name): PATRICIA JEANTY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10448 S PULASKI RD STE 6
OAK LAWN IL
60453-4895
US

IV. Provider business mailing address

10448 S PULASKI RD STE 6
OAK LAWN IL
60453-4895
US

V. Phone/Fax

Practice location:
  • Phone: 773-449-1927
  • Fax: 708-570-0434
Mailing address:
  • Phone: 773-449-1927
  • Fax: 708-570-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277001117
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008720
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: