Provider Demographics
NPI:1457997561
Name:SINGH, JASLEEN MOHINI (PA-C)
Entity Type:Individual
Prefix:
First Name:JASLEEN
Middle Name:MOHINI
Last Name:SINGH
Suffix:
Gender:F
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 1:1645A W SCHOOL STREET
Mailing Address - Street 2:SUITE A,CLINIC ENTRANCE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-227-3669
Mailing Address - Fax:
Practice Address - Street 1:1645A W SCHOOL STREET
Practice Address - Street 2:SUITE A, CLINIC ENTRANCE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-227-3669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007142363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty