Provider Demographics
NPI:1346786803
Name:JAKUPOVIC, SHERI NICHOLE (APN)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:NICHOLE
Last Name:JAKUPOVIC
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7343 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2206
Mailing Address - Country:US
Mailing Address - Phone:708-231-8908
Mailing Address - Fax:
Practice Address - Street 1:7343 LAKE ST
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2206
Practice Address - Country:US
Practice Address - Phone:708-231-8908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041397892363L00000X
IL209015114363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209015114Medicaid
ILMM4286490OtherDEA