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General NPI Number Information
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NPI Number | 1841562733
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Entity Type | Individual
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Provider Name | PAMELA SUZANNE JACKS PORTNOY RN, FNP, DNP
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Gender | Female
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 1300 W BELMONT AVE STE 100
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City | CHICAGO
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State | IL
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Zip | 60657-3200
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Country | US
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Telephone | 773-975-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 W BELMONT AVE STE 100
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City | CHICAGO
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State | IL
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Zip | 60657-3200
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Country | US
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Telephone | 773-975-8900
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Fax | 773-975-8901
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041-570423
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21608
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 766010
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 277-003899
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 377-003662
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License Number State | IL
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