Provider Demographics
NPI:1912561267
Name:NOTO, JACLYN (CNM, APRN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:NOTO
Suffix:
Gender:
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 FRONTAGE RD
Mailing Address - Street 2:SUITE 3825
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:847-920-4613
Mailing Address - Fax:800-511-4829
Practice Address - Street 1:550 FRONTAGE RD
Practice Address - Street 2:SUITE 3825
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-920-4613
Practice Address - Fax:800-511-4829
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002618176B00000X, 363LP0808X, 367A00000X, 2084P0800X
IL209.019162363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife