Provider Demographics
NPI:1720003577
Name:STERN, JANICE E (ARNP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:E
Last Name:STERN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 W JACKSON BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3276
Mailing Address - Country:US
Mailing Address - Phone:312-942-8387
Mailing Address - Fax:312-942-8374
Practice Address - Street 1:1645 W JACKSON BLVD STE 602
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-8387
Practice Address - Fax:312-942-8374
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP0005491363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0201797OtherL&I
WA9636879Medicaid
WAP80777Medicare UPIN
WA9636879Medicaid