Provider Demographics
NPI:1114397353
Name:SMITH, JESSICA LEIGH (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:2100 PFINGSTEN RD
Mailing Address - Street 2:DEPT. OF SURGERY
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1301
Mailing Address - Country:US
Mailing Address - Phone:847-657-5815
Mailing Address - Fax:847-657-3724
Practice Address - Street 1:2100 PFINGSTEN RD
Practice Address - Street 2:DEPT. OF SURGERY
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1301
Practice Address - Country:US
Practice Address - Phone:847-657-5815
Practice Address - Fax:847-657-3724
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085.005597363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical