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General NPI Number Information
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NPI Number | 1144917899
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Entity Type | Individual
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Provider Name | JAYA ROBERT LUIS PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 28 N 1ST ST STE 201
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City | GENEVA
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State | IL
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Zip | 60134-2285
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Country | US
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Telephone | 888-428-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 783 WATERSIDE DR
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-3718
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Country | US
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Telephone | 847-909-3196
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209026930
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License Number State | IL
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