Provider Demographics
NPI:1154724680
Name:VAN DE HEY, JORDIN J (PA-C)
Entity type:Individual
Prefix:
First Name:JORDIN
Middle Name:J
Last Name:VAN DE HEY
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:479-826-7158
Mailing Address - Fax:847-982-3394
Practice Address - Street 1:9669 KENTON AVE STE 602
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1248
Practice Address - Country:US
Practice Address - Phone:847-236-1300
Practice Address - Fax:847-933-3565
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2024-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI3438-23363A00000X
IL085006536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant