Provider Demographics
NPI:1548552599
Name:JEANTY, PATRICIA (NP-C)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:JEANTY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10448 S PULASKI RD STE 6
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4895
Mailing Address - Country:US
Mailing Address - Phone:773-449-1927
Mailing Address - Fax:708-570-0434
Practice Address - Street 1:10448 S PULASKI RD STE 6
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4895
Practice Address - Country:US
Practice Address - Phone:773-449-1927
Practice Address - Fax:708-570-0434
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008720363LF0000X
IL277001117363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7356OtherPTAN