MEDICARE: LACI CHRISTINE JANKOWSKI APN

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	363LA2200X	Adult Health Nurse Practitioner	041-398735	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041-398735	OTHER	IL	STATE OF ILLINOIS LICENSES NUMBER

General Provider Information

NPI Number	:	1689945339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACI CHRISTINE JANKOWSKI APN

Provider Business Mailing Address
First Line	:	490 W LEBANON ST
Second Line	:
City	:	NASHVILLE
State	:	IL
Zip	:	62263-1349
Country	:	US
Telephone Number	:	618-521-1657
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 MCPHERSON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2831
Country	:	US
Telephone Number	:	618-241-1360
Fax Number	:	618-241-1865

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

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	01/05/2021

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