Healthcare Provider Details

I. General information

NPI: 1699715706
Provider Name (Legal Business Name): JACQUELINE G MAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE G DEMPSEY NP

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 ROXBURY RD
ROCKFORD IL
61107-5089
US

IV. Provider business mailing address

612 ROXBURY RD
ROCKFORD IL
61107-5089
US

V. Phone/Fax

Practice location:
  • Phone: 815-227-8300
  • Fax: 815-227-8301
Mailing address:
  • Phone: 815-227-8300
  • Fax: 815-227-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209001516
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209001516
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number41177965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: