Provider Demographics
NPI:1700853496
Name:OELERICH, JEANNE M (APRN FPA)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:M
Last Name:OELERICH
Suffix:
Gender:F
Credentials:APRN FPA
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:COCKRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2000 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7222
Mailing Address - Country:US
Mailing Address - Phone:630-978-6250
Mailing Address - Fax:630-978-6869
Practice Address - Street 1:2000 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-978-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041300447363L00000X
IL041-300447363LA2200X
IL277000260364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49680OtherPTAN INDIVIDUAL
993010OtherPTAN GROUP
ILK49680OtherPTAN INDIVIDUAL