Provider Demographics
NPI:1184920084
Name:JASZAROWSKI, KELLY ANN (RN, CWOCN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:JASZAROWSKI
Suffix:
Gender:F
Credentials:RN, CWOCN
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:FORAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5409 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5069
Mailing Address - Country:US
Mailing Address - Phone:309-683-6205
Mailing Address - Fax:309-691-4543
Practice Address - Street 1:5409 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5069
Practice Address - Country:US
Practice Address - Phone:309-683-6205
Practice Address - Fax:309-691-4543
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL029.002704364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist