Provider Demographics
NPI:1225681455
Name:JOSS, JINU (MSN,AGNP-C)
Entity Type:Individual
Prefix:
First Name:JINU
Middle Name:
Last Name:JOSS
Suffix:
Gender:F
Credentials:MSN,AGNP-C
Other - Prefix:
Other - First Name:JINU
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,BSN
Mailing Address - Street 1:9939 N WARREN OVAL
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1044
Mailing Address - Country:US
Mailing Address - Phone:309-868-7216
Mailing Address - Fax:
Practice Address - Street 1:9939 N WARREN OVAL
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1044
Practice Address - Country:US
Practice Address - Phone:309-868-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019295363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty