MISS JACQUELINE ROSE ZDON (NPI# 1003194796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003194796 |
| Entity Type | Individual |
| Full Name | MISS JACQUELINE ROSE ZDON |
| Other Name | MISS JACKIE R ZDON |
| Credential | PA-C |
| Practice Address |
4400 W 95th St Suite 205 Oak Lawn IL 60453-2654 |
| Practice Telephone | 7083464040 |
| Practice Fax Number | 7083463287 |
| Mailing Telephone | 7083464040 |
| Mailing Fax Number | 7083463287 |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2012-02-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
2832-023 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085-004090 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1003194796 | 05 |
| Street Address |
4400 W 95TH ST SUITE 205 |
| City | OAK LAWN |
| State | IL |
| Zip Code | 60453-2654 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366445678 | Richard Z Belch | Specialist | 4400 W 95th St, Suite 207, Oak Lawn, IL 60453-2654 | 2005-05-31 |
| 1629683289 | Allison Gilbert | Nurse Practitioner | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2020-09-10 |
| 1164054011 | Elizabeth Gawne | Nurse Practitioner | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2020-02-09 |
| 1770128175 | Brittany Snyder | Physician Assistant | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2019-11-10 |
| 1730723446 | Christina M Tortorici | Physician Assistant | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2019-11-06 |
| 1437610805 | Duhah Hamayel | Pediatrics | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2019-03-28 |
| 1790246205 | Shawn Buxton | Pediatrics | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2019-03-27 |
| 1619456506 | Betty Joechle | Registered Nurse | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2018-08-10 |
| 1700372174 | Amy Elizabeth Calandriello | Registered Nurse | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2018-07-09 |
| 1801380563 | Corissa Nicole Culichia | Pediatrics | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2018-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659995231 | Natalia Zero | Student in an Organized Health Care Education/Training Program | 4440 W 95th St, Rm 131 North, Oak Lawn, IL 60453 | 2020-05-30 |
| 1114554300 | Sylvia Maria Chlebek | Student in an Organized Health Care Education/Training Program | Advocate Christ Medical Center 4440 W. 95th St., Rm 131 North, Oak Lawn, IL 60453 | 2020-03-26 |
| 1972066751 | Amanda Mroczek | Family Medicine | 9555 52nd Avenue, Suite F, Oak Lawn, IL 60453 | 2019-04-09 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1659833473 | Chelsea Sumida Gipson | Family Medicine | 9555 South 52nd Avenue, Suite F, Oak Lawn, IL 60453 | 2019-04-01 |
| 1518427418 | Robert Lindgren | Family Medicine | 9555 S. 52nd Ave., Suite F, Oak Lawn, IL 60453 | 2019-03-25 |
| 1154886695 | Stephanie Anne Comer | Social Worker | 10102 South Cicero Avenue, Suite C, Oak Lawn, IL 60453 | 2019-02-08 |
| 1700360070 | Brian L Lee | Counselor | 8938 S Ridgeland Avenue Suite 100, Oak Lawn, IL 60453 | 2018-09-21 |
| 1679085245 | International Dental of Oak Lawn | Clinic/Center | 9539 S Cicero Ave, Oak Lawn, IL 60453 | 2017-11-03 |
| 1124538301 | Kavitha Rajendran | Physician Assistant | 5851 W. 95th Street, Suite 300, Oak Lawn, IL 60453 | 2017-10-02 |
| Find all providers in zip 60453 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1730723446 | Christina M Tortorici | Physician Assistant | 4400 W 95th St, Oak Lawn, IL 60453-2654 | 2019-11-06 |
| 1043777832 | Catherine Gaissert | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2019-02-27 |
| 1407327638 | Dakota Walther | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2018-12-16 |
| 1538644273 | Katarzyna M Krzycka | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2018-09-28 |
| 1518463330 | Nicole Annes | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2018-04-02 |
| 1851809560 | Deirdre Vaughan Howard | Physician Assistant | 4400 W 95th St Ste 407, Oak Lawn, IL 60453-2654 | 2018-01-16 |
| 1891208617 | Jenifer K Wong-yu | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2017-11-15 |
| 1245753417 | Kayla Antle | Physician Assistant | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2017-07-19 |
| 1629524251 | Steven Collins | Physician Assistant | 4400 W 95th St Ste 308, Oak Lawn, IL 60453-2660 | 2016-09-01 |
| Find all providers in OAK LAWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.