Provider Demographics
NPI:1134817653
Name:BACCAY, JACQUELINE CHAN (RN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CHAN
Last Name:BACCAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:MAMIGO
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:283 KING LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5953
Mailing Address - Country:US
Mailing Address - Phone:847-219-7188
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-3871
Practice Address - Fax:224-610-2958
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041269945163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice