Provider Demographics
NPI:1619715273
Name:CONNORS, JAYNE
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:CONNORS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8553 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1636
Mailing Address - Country:US
Mailing Address - Phone:708-334-6079
Mailing Address - Fax:
Practice Address - Street 1:8553 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1636
Practice Address - Country:US
Practice Address - Phone:708-334-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications