Provider Demographics
NPI:1841562733
Name:PORTNOY, PAMELA SUZANNE JACKS (RN, FNP, DNP)
Entity type:Individual
Prefix:
First Name:PAMELA SUZANNE JACKS
Middle Name:
Last Name:PORTNOY
Suffix:
Gender:F
Credentials:RN, FNP, DNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:SUZANNE
Other - Last Name:JACKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 W BELMONT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3200
Mailing Address - Country:US
Mailing Address - Phone:773-975-8900
Mailing Address - Fax:773-975-8901
Practice Address - Street 1:1300 W BELMONT AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:773-975-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-570423163W00000X
CA21608363LF0000X
CA766010163W00000X
IL277-003899363L00000X
IL377-003662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner