Provider Demographics
NPI:1962526582
Name:JOY, JO M (PA)
Entity type:Individual
Prefix:MRS
First Name:JO
Middle Name:M
Last Name:JOY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD ROAD
Mailing Address - Street 2:#519
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190
Mailing Address - Country:US
Mailing Address - Phone:630-668-2180
Mailing Address - Fax:630-668-2195
Practice Address - Street 1:25 N WINFIELD ROAD
Practice Address - Street 2:#519
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:630-668-2180
Practice Address - Fax:630-668-2195
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002885363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085-002885OtherPHYSICIAN ASST LICENSE