Provider Demographics
NPI:1477081263
Name:DUBIK, JAYCI NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:JAYCI
Middle Name:NICOLE
Last Name:DUBIK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 WILLOW SPRINGS ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAGRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-482-4500
Mailing Address - Fax:708-482-4502
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 110
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6504
Practice Address - Country:US
Practice Address - Phone:708-482-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016008363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty