Provider Demographics
NPI:1588447205
Name:YI, JAMIE (APN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 PERRIE DR # 502-2
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7904
Mailing Address - Country:US
Mailing Address - Phone:224-688-7964
Mailing Address - Fax:
Practice Address - Street 1:1350 N WELLS ST STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1936
Practice Address - Country:US
Practice Address - Phone:312-638-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027414363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner