Provider Demographics
NPI:1841249620
Name:JAGODZINSKI, NANCY A (DPM)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:JAGODZINSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N RIVER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8950
Mailing Address - Country:US
Mailing Address - Phone:630-778-7670
Mailing Address - Fax:630-778-7671
Practice Address - Street 1:620 N RIVER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8950
Practice Address - Country:US
Practice Address - Phone:630-778-7670
Practice Address - Fax:630-778-7671
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004352213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-004352OtherPODIATRIC PHYSICIAN/SURG
IL016-004352OtherPODIATRIC PHYSICIAN/SURG
IL911051Medicare ID - Type Unspecified