Provider Demographics
NPI:1326359100
Name:HANSBERRY, JADA H (PA-C)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:H
Last Name:HANSBERRY
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 PAYSPHERE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60067
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:847-535-8109
Practice Address - Street 1:9300 WAUKEGAN ROAD
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053
Practice Address - Country:US
Practice Address - Phone:847-675-3900
Practice Address - Fax:847-675-3930
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003760OtherSTATE LICENCE