Provider Demographics
NPI:1700211372
Name:WINN-TONEY, JACQUELINE ALBERTA (RN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ALBERTA
Last Name:WINN-TONEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 N MAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1895
Mailing Address - Country:US
Mailing Address - Phone:708-252-4112
Mailing Address - Fax:
Practice Address - Street 1:1316 N MAYWOOD DR
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1895
Practice Address - Country:US
Practice Address - Phone:708-252-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41237742163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041237742OtherREGISTERED PROFESSIONAL NURSE