Provider Demographics
NPI:1679868996
Name:ANICHINI, JANE (APRN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ANICHINI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 N WILTON AVE
Mailing Address - Street 2:ATTN: CREDENTIALING DPT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6710
Mailing Address - Country:US
Mailing Address - Phone:773-296-7580
Mailing Address - Fax:
Practice Address - Street 1:845 W WILSON AVE
Practice Address - Street 2:ATTN: CREDENTIALING DPT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-8090
Practice Address - Country:US
Practice Address - Phone:773-506-4283
Practice Address - Fax:773-506-4847
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041580175163W00000X
CT004766363LF0000X
IL209010140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209010140Medicaid
CT004236346Medicaid