Provider Demographics
NPI:1568187748
Name:ALEKSICH, JACLYN ASHLEY (DNP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ASHLEY
Last Name:ALEKSICH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14511 E IL ROUTE 72
Mailing Address - Street 2:
Mailing Address - City:DAVIS JUNCTION
Mailing Address - State:IL
Mailing Address - Zip Code:61020-9775
Mailing Address - Country:US
Mailing Address - Phone:847-373-7068
Mailing Address - Fax:
Practice Address - Street 1:5668 E STATE ST STE 2000
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2491
Practice Address - Country:US
Practice Address - Phone:815-381-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily