Provider Demographics
NPI:1508549742
Name:SALAKSANA, JESSICA YVONNE (APRN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:YVONNE
Last Name:SALAKSANA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 LAKEVIEW PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1822
Mailing Address - Country:US
Mailing Address - Phone:224-998-5450
Mailing Address - Fax:
Practice Address - Street 1:214 CENTERVIEW DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5274
Practice Address - Country:US
Practice Address - Phone:913-222-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner