MEDICARE: MRS. LINDA DARNELL JILES NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner		IL

General Provider Information

NPI Number	:	1497869424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA DARNELL JILES NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2932 W 86TH PLACE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3830
Country	:	US
Telephone Number	:	773-436-1028
Fax Number	:	773-436-8959

Provider Business Practice Location Address
First Line	:	2932 W 86TH PLACE
Second Line	:
City	:	CHICAGO
State	:	IN
Zip	:	60652-3830
Country	:	US
Telephone Number	:	773-436-1028
Fax Number	:	773-436-8959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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