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General NPI Number Information
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NPI Number | 1154121044
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Entity Type | Individual
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Provider Name | JADE NICOLE RODRIGUEZ APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1016 W LAKE ST
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City | CHICAGO
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State | IL
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Zip | 60607-1715
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Country | US
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Telephone | 847-506-9767
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Fax | 847-507-9769
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Provider Business Mailing Address
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Address Line | 2364 ESSINGTON RD STE 146
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City | JOLIET
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State | IL
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Zip | 60435-1664
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Country | US
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Telephone | 708-336-0294
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.031877
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.473064
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License Number State | IL
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