Provider Demographics
NPI:1811290216
Name:PIZINGER, JACQUELINE KELLY (APN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KELLY
Last Name:PIZINGER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1445 ESSINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2886
Mailing Address - Country:US
Mailing Address - Phone:815-741-6900
Mailing Address - Fax:
Practice Address - Street 1:1445 ESSINGTON ROAD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2886
Practice Address - Country:US
Practice Address - Phone:815-741-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008277207X00000X
IL209-008277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209008277Medicaid