Healthcare Provider Details

I. General information

NPI: 1093170565
Provider Name (Legal Business Name): JANE POMRANKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE ELIZABETH BROWN NP-C

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17495 LA GRANGE RD
TINLEY PARK IL
60487-7581
US

IV. Provider business mailing address

17495 LA GRANGE RD
TINLEY PARK IL
60487-7581
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-7000
  • Fax: 708-226-7174
Mailing address:
  • Phone: 708-226-7000
  • Fax: 708-226-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013317
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: