Provider Demographics
NPI:1861826604
Name:JARRETT-RODNEY, PAULETTE Y (FNP)
Entity type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:Y
Last Name:JARRETT-RODNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:PAULETTE
Other - Middle Name:Y
Other - Last Name:JARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:271 SILVER LN
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-2536
Mailing Address - Country:US
Mailing Address - Phone:708-345-2505
Mailing Address - Fax:
Practice Address - Street 1:1649 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-5207
Practice Address - Country:US
Practice Address - Phone:773-278-6868
Practice Address - Fax:773-278-6922
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363LF0000XMedicaid