Provider Demographics
NPI:1659909372
Name:ANDERSON, JAELYN LOIS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAELYN
Middle Name:LOIS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JAELYN
Other - Middle Name:LOIS
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-0095
Mailing Address - Country:US
Mailing Address - Phone:815-802-0000
Mailing Address - Fax:815-935-1000
Practice Address - Street 1:70 MEADOWVIEW CTR STE 200
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2063
Practice Address - Country:US
Practice Address - Phone:815-802-0000
Practice Address - Fax:815-935-1000
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021128363LF0000X
IN71010380A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner