Agnes, Jeric

Agnes, Jeric is an individual health care provider with primary practice located at 3880 Salem Lake Dr Ste F , Long Grove IL 60047-5292. He recently has 3 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is his primary health care specialty. Agnes, Jeric can be contacted via phone (847) 719-2220.

Contact Information

Primary practice address
3880 Salem Lake Dr Ste F Long Grove IL 60047-5292
Phone: (847) 719-2220
Fax: (847) 719-2265
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 041435789 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209021968 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 209021968 Illinois

Profile Details

NPI number 1114532611
LBN Legal business name Agnes, Jeric
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 10th, 2020
Last updated Oct 25th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114532611 NPPES
Illinois MEDICAID 209021968
Illinois Other MA6346173

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