Provider Demographics
NPI:1023787363
Name:DEJESUS, PAULINE (RN)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:DEJESUS
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 1:727 DAYBREAK LN
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-3614
Mailing Address - Country:US
Mailing Address - Phone:630-400-5220
Mailing Address - Fax:
Practice Address - Street 1:727 DAYBREAK LN
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-3614
Practice Address - Country:US
Practice Address - Phone:630-400-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041445495163W00000X
IL209027999367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse