Petrov, Jaclyn Mary

Petrov, Jaclyn Mary is an individual health care provider with primary practice located at 10260 191St St Ste 100 , Mokena IL 60448-8802. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology, which is considered as her primary health care specialty. Petrov, Jaclyn Mary can be contacted via phone (708) 572-7669.

Contact Information

Primary practice address
10260 191St St Ste 100 Mokena IL 60448-8802
Phone: (708) 572-7669
Fax: (708) 422-4253
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology 363LX0001X 209.019158 Indiana

Profile Details

NPI number 1295399178
LBN Legal business name Petrov, Jaclyn Mary
Credentials Advanced Practice Nurse (APN)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2019
Last updated Sep 28th, 2022 - about 2 years ago

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 1295399178 NPPES
Illinois Other 209.019158 APN LICENSE

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