Healthcare Provider Details

I. General information

NPI: 1831108208
Provider Name (Legal Business Name): JANETTE SUE JONES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 WALNUT ST
ST CHARLES IL
60174-2725
US

IV. Provider business mailing address

318 WALNUT ST
ST CHARLES IL
60174-2725
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-9277
  • Fax: 630-377-9729
Mailing address:
  • Phone: 630-377-9277
  • Fax: 630-377-9729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041.407476
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.010255
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: