Provider Demographics
NPI:1881223998
Name:MIGLIARESE, JACLYN ELIZABETH (DNP, CRNA)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:ELIZABETH
Last Name:MIGLIARESE
Suffix:
Gender:F
Credentials:DNP, CRNA
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Other - First Name:
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Mailing Address - Street 1:437 W DIVISION ST APT 909
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1762
Mailing Address - Country:US
Mailing Address - Phone:312-848-8022
Mailing Address - Fax:
Practice Address - Street 1:1800 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3810
Practice Address - Country:US
Practice Address - Phone:217-464-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041421969367500000X
IL209022004367500000X
IL277002375367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered