Provider Demographics
NPI:1154417160
Name:SVARA, JACQUELINE P (ND, APN/CNP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:P
Last Name:SVARA
Suffix:
Gender:F
Credentials:ND, APN/CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3965 75TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7925
Mailing Address - Country:US
Mailing Address - Phone:630-375-1625
Mailing Address - Fax:630-375-1925
Practice Address - Street 1:3965 75TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7925
Practice Address - Country:US
Practice Address - Phone:630-375-1625
Practice Address - Fax:630-375-1925
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK15145Medicare ID - Type Unspecified
ILQ36797Medicare UPIN