Provider Demographics
NPI:1649228701
Name:JAISINGH, NATHAN R (NP)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:R
Last Name:JAISINGH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-0379
Mailing Address - Country:US
Mailing Address - Phone:708-460-9833
Mailing Address - Fax:708-460-1117
Practice Address - Street 1:11231 DISTINCTIVE DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9458
Practice Address - Country:US
Practice Address - Phone:708-460-9833
Practice Address - Fax:708-460-1117
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-322947163W00000X
IL209-004600363L00000X
IL0376062-34363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00476630OtherPALMETTO
IL726880OtherASSOCIATION INDIVIDUAL DEVELOPMENT GROUP#
IL041322947Medicaid
ILP00476630OtherPALMETTO
IL726880OtherASSOCIATION INDIVIDUAL DEVELOPMENT GROUP#
IL208651Medicare ID - Type Unspecified
IL041322947Medicaid