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General NPI Number Information
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NPI Number | 1013370857
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Entity Type | Individual
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Provider Name | DELOVELY GLORIA JACKSON FNP
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Gender | Female
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 1400 OTTO BLVD
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3741
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Country | US
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Telephone | 708-733-7200
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Fax | 708-733-7222
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Provider Business Mailing Address
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Address Line | 35318 EAGLE WAY
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City | CHICAGO
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State | IL
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Zip | 60678-0353
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277001922
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209013987
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License Number State | IL
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