=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780496646
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA MARIA JAJESNIAK APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5851 W 95TH ST STE 400
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-2415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-857-7230
-----------------------------------------------------
Fax | 708-425-5779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10231 HAWTHORNE DR
-----------------------------------------------------
City | ORLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60462-3025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-267-3642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 209031491
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------