Provider Demographics
NPI:1336265206
Name:JACOVICH-OCHWAT, CAROL ANN JANE (RN, CRNFA)
Entity Type:Individual
Prefix:MRS
First Name:CAROL ANN
Middle Name:JANE
Last Name:JACOVICH-OCHWAT
Suffix:
Gender:F
Credentials:RN, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S WILKE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-7629
Mailing Address - Country:US
Mailing Address - Phone:847-577-5461
Mailing Address - Fax:847-577-5471
Practice Address - Street 1:704 S WILKE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-7629
Practice Address - Country:US
Practice Address - Phone:847-577-5461
Practice Address - Fax:847-577-5471
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0041-307612163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant