Provider Demographics
NPI:1124454087
Name:BORRELLI, JEAN M (APN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:BORRELLI
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 1:6702 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1320
Mailing Address - Country:US
Mailing Address - Phone:773-775-6105
Mailing Address - Fax:773-775-7106
Practice Address - Street 1:6702 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1320
Practice Address - Country:US
Practice Address - Phone:773-775-6105
Practice Address - Fax:773-775-7106
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003640367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife