Provider Demographics
NPI:1558431783
Name:JUSKO, JONATHAN ERIC (RN, PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ERIC
Last Name:JUSKO
Suffix:
Gender:M
Credentials:RN, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S KENNEDY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2682
Mailing Address - Country:US
Mailing Address - Phone:815-928-8060
Mailing Address - Fax:800-505-2218
Practice Address - Street 1:400 S KENNEDY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2682
Practice Address - Country:US
Practice Address - Phone:815-928-8060
Practice Address - Fax:800-505-2218
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002855363AS0400X
IN10000984A363AS0400X
IN28154059A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618941OtherBLUECROSS/BLUESHIELD
ILP00668381Medicare PIN
ILK32088Medicare PIN
IL01618941OtherBLUECROSS/BLUESHIELD
ILK35455Medicare PIN
ILK34251Medicare PIN
IN408430DDMedicare PIN
ILQ72616Medicare UPIN