Provider Demographics
NPI:1083160840
Name:VICKERS, JAMMIE (APN)
Entity Type:Individual
Prefix:
First Name:JAMMIE
Middle Name:
Last Name:VICKERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PAYSHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-1023
Mailing Address - Country:US
Mailing Address - Phone:630-545-6016
Mailing Address - Fax:630-545-4064
Practice Address - Street 1:1802 N DIVISION ST STE 701
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3120
Practice Address - Country:US
Practice Address - Phone:815-942-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014771363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health