Provider Demographics
NPI:1043373160
Name:MACARY, JEAN Z (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:Z
Last Name:MACARY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6141
Mailing Address - Country:US
Mailing Address - Phone:630-545-3760
Mailing Address - Fax:630-545-3769
Practice Address - Street 1:885 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6141
Practice Address - Country:US
Practice Address - Phone:630-545-3760
Practice Address - Fax:630-545-3769
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004418363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01388337OtherMEDICARE RAILROAD (INDIVIDUAL PTAN)
ILCA4748OtherMEDICARE RAILROAD (GROUP PTAN)
ILF400136279OtherMEDICARE PTAN (INDIVIDUAL)
IL92540OtherMEDICARE PTAN (GROUP)
ILP01388337OtherMEDICARE RAILROAD (INDIVIDUAL PTAN)