Provider Demographics
NPI:1972636157
Name:CHASANOV, JILL (RN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CHASANOV
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 BUSSE HWY
Mailing Address - Street 2:MAINE CENTER
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2360
Mailing Address - Country:US
Mailing Address - Phone:847-696-1570
Mailing Address - Fax:847-696-1587
Practice Address - Street 1:819 BUSSE HWY
Practice Address - Street 2:MAINE CENTER
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2360
Practice Address - Country:US
Practice Address - Phone:847-696-1570
Practice Address - Fax:847-696-1587
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse