Provider Demographics
NPI:1588705651
Name:STRAZAR, JEAN ELLEN (APN)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ELLEN
Last Name:STRAZAR
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 1:50 NORTHGATE INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-6805
Mailing Address - Country:US
Mailing Address - Phone:618-877-4420
Mailing Address - Fax:
Practice Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040
Practice Address - Country:US
Practice Address - Phone:618-877-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309.003146363LF0000X, 363LP0808X
IL209-005871363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.005871OtherSTATE LICENSURE
IL309.003146OtherLICENSE WITH CONTROLLED SUBSTANCE
IL041.214555OtherSTATE LICENSURE- RN
IL041.214555OtherSTATE LICENSURE- RN