Provider Demographics
NPI:1922369958
Name:CHUPICH, JEANNE MARIE (APN)
Entity Type:Individual
Prefix:MISS
First Name:JEANNE
Middle Name:MARIE
Last Name:CHUPICH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16809 OBRIEN RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-9536
Mailing Address - Country:US
Mailing Address - Phone:815-648-4770
Mailing Address - Fax:
Practice Address - Street 1:1415 E STATE STEEET
Practice Address - Street 2:SUITE 800
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2333
Practice Address - Country:US
Practice Address - Phone:815-965-2809
Practice Address - Fax:815-965-8974
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004152364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health