Provider Demographics
NPI:1720476963
Name:CALDERALA, JENNIFER L (APRN, CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CALDERALA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:626 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4939
Mailing Address - Country:US
Mailing Address - Phone:815-306-2700
Mailing Address - Fax:815-306-2715
Practice Address - Street 1:626 BETHANY RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4939
Practice Address - Country:US
Practice Address - Phone:815-306-2700
Practice Address - Fax:815-306-2715
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041376559163W00000X
IL209011970363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse