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General NPI Number Information
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NPI Number | 1093285868
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Entity Type | Individual
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Provider Name | JESSICA WHITE PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 1101 LAKE ST STE 302
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City | OAK PARK
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State | IL
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Zip | 60301-1047
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Country | US
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Telephone | 630-261-1210
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Fax | 630-261-1211
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Provider Business Mailing Address
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Address Line | 3601 MCCORMICK AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1615
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Country | US
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Telephone | 708-299-6186
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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