Provider Demographics
NPI:1295196632
Name:JONES, BRENDA YVETTE (NP-C, APN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:YVETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:NP-C, APN
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:YVETTE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:9119 S EXCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4225
Mailing Address - Country:US
Mailing Address - Phone:773-768-5000
Mailing Address - Fax:
Practice Address - Street 1:9119 S EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:773-768-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-13
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053493Medicaid
ILC49130Medicare UPIN