Provider Demographics
NPI:1215224274
Name:ROHALY-DAVIS, JACQUELINE ANN (MS, APRN, AOCN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANN
Last Name:ROHALY-DAVIS
Suffix:
Gender:F
Credentials:MS, APRN, AOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15750 MARIAN DR
Mailing Address - Street 2:ONCOLOGY
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6200
Mailing Address - Country:US
Mailing Address - Phone:708-645-3512
Mailing Address - Fax:708-645-3423
Practice Address - Street 1:15750 MARIAN DR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-6200
Practice Address - Country:US
Practice Address - Phone:708-645-3512
Practice Address - Fax:708-645-3423
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003904364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology