Provider Demographics
NPI:1477168326
Name:MCPHEETERS, JACLYN MARIEV (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIEV
Last Name:MCPHEETERS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17960 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2014
Mailing Address - Country:US
Mailing Address - Phone:708-922-0911
Mailing Address - Fax:
Practice Address - Street 1:17960 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2014
Practice Address - Country:US
Practice Address - Phone:708-923-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily