Provider Demographics
NPI:1154796902
Name:CADDICK, JEAN MARIE (APN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:CADDICK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:SLANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:801 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7430
Mailing Address - Country:US
Mailing Address - Phone:630-527-3000
Mailing Address - Fax:
Practice Address - Street 1:801 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7430
Practice Address - Country:US
Practice Address - Phone:630-527-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1635912163W00000X
COAPN.0992017-NP363LA2100X
IL209013389363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse