Provider Demographics
NPI:1184296303
Name:JENT, NATHAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:JENT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N MICHIGAN AVE STE 1605
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7478
Mailing Address - Country:US
Mailing Address - Phone:312-201-1234
Mailing Address - Fax:312-994-3000
Practice Address - Street 1:180 N MICHIGAN AVE STE 1605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7478
Practice Address - Country:US
Practice Address - Phone:312-201-1234
Practice Address - Fax:312-201-1202
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.008383363AS0400X
IL085008383363A00000X
IN10003556A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical