Provider Demographics
NPI:1033939905
Name:JACI NOTO LLC
Entity type:Organization
Organization Name:JACI NOTO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FPA
Authorized Official - Phone:847-530-0937
Mailing Address - Street 1:1104 MARGRET ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6321
Mailing Address - Country:US
Mailing Address - Phone:847-530-0937
Mailing Address - Fax:
Practice Address - Street 1:550 W FRONTAGE RD STE 3825
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1262
Practice Address - Country:US
Practice Address - Phone:847-530-0937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty