Provider Demographics
NPI:1023360781
Name:VELIYATHUMALIL, JASSEENA BINCE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JASSEENA
Middle Name:BINCE
Last Name:VELIYATHUMALIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JASSEENA
Other - Middle Name:
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:314 N MARCELLA RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2615
Mailing Address - Country:US
Mailing Address - Phone:847-759-9973
Mailing Address - Fax:
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:847-770-2598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily