Provider Demographics
NPI:1619621786
Name:VELASCO, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:VELASCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SKOKIE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2841
Mailing Address - Country:US
Mailing Address - Phone:847-644-3628
Mailing Address - Fax:847-305-5886
Practice Address - Street 1:707 SKOKIE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2841
Practice Address - Country:US
Practice Address - Phone:847-644-3628
Practice Address - Fax:847-305-5886
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041411396163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse