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General NPI Number Information
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NPI Number | 1124396221
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Entity Type | Individual
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Provider Name | LINDA J JURETSCHKE PHD, APN/NNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE RUSSO, 5TH FLOOR, NEONATAL
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-8261
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Fax | 708-216-4125
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Provider Business Mailing Address
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Address Line | 2160 S 1ST AVE RUSSO, 5TH FLOOR, NEONATAL
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-8261
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Fax | 708-216-4125
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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 | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 209-000173
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License Number State | IL
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