Provider Demographics
NPI:1952768210
Name:CHRISTIE, JACQUELINE (APN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 AUDREY NIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-1618
Mailing Address - Country:US
Mailing Address - Phone:847-377-8800
Mailing Address - Fax:847-377-8801
Practice Address - Street 1:2215 AUDREY NIXON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-1618
Practice Address - Country:US
Practice Address - Phone:847-377-8800
Practice Address - Fax:847-377-8801
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277001997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty