Provider Demographics
NPI:1194156307
Name:FISHMAN, JELENA (FNP)
Entity type:Individual
Prefix:
First Name:JELENA
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49W161 HINCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:BIG ROCK
Mailing Address - State:IL
Mailing Address - Zip Code:60511-9314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49W161 HINCKLEY RD
Practice Address - Street 2:
Practice Address - City:BIG ROCK
Practice Address - State:IL
Practice Address - Zip Code:60511-9314
Practice Address - Country:US
Practice Address - Phone:773-330-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041361670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily