Provider Demographics
NPI:1265774806
Name:RODRIGUEZ, JESSICA E (PA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:E
Other - Last Name:EISENHAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:550 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3186
Mailing Address - Country:US
Mailing Address - Phone:630-323-6116
Mailing Address - Fax:630-794-8615
Practice Address - Street 1:1870 SILVER CROSS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-8639
Practice Address - Country:US
Practice Address - Phone:815-462-3474
Practice Address - Fax:630-794-8615
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004671363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085004617OtherPHYSICIAN ASSISTANT LICENSE