Provider Demographics
NPI:1609768647
Name:JANIK, JAIMIE (FNP)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:
Last Name:JANIK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11105 W ELMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9215
Mailing Address - Country:US
Mailing Address - Phone:815-666-4234
Mailing Address - Fax:
Practice Address - Street 1:10074 W 190TH PL STE 10074
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8752
Practice Address - Country:US
Practice Address - Phone:708-995-5894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.032735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty