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NPI Code Detail

MEDICARE: JET GADISSON DNP

MEDICARE: JET GADISSON DNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner277.000820IL
2363L00000XNurse Practitioner277000820IL

General Provider Information

NPI Number : 1609205657
Entity Type Code : Individual
Provider Name (Legal Business Name) : JET GADISSON DNP
Provider Business Mailing Address
First Line : 750 OAKMONT LN
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5551
Country : US
Telephone Number : 630-861-1500
Fax Number :
Provider Business Practice Location Address
First Line : 750 OAKMONT LN
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5551
Country : US
Telephone Number : 630-861-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2013
Last Update Date : 01/13/2026

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