Provider Demographics
NPI:1134108947
Name:EAKER, JEAN R (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:R
Last Name:EAKER
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 1:1280 E TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-1912
Mailing Address - Country:US
Mailing Address - Phone:217-532-2320
Mailing Address - Fax:
Practice Address - Street 1:1280 E TREMONT ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-1912
Practice Address - Country:US
Practice Address - Phone:217-532-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08220357OtherBCBS OF IL GRP#
ILP00239252OtherRAILROAD MEDICARE
ILQ22469Medicare UPIN
ILK20194Medicare ID - Type Unspecified