Jackson, Delovely Gloria

Jackson, Delovely Gloria is an individual health care provider with primary practice located at 1400 Otto Blvd , Chicago Heights IL 60411-3741. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Jackson, Delovely Gloria can be contacted via phone (708) 733-7200.

Contact Information

Primary practice address
1400 Otto Blvd Chicago Heights IL 60411-3741
Phone: (708) 733-7200
Fax: (708) 733-7222
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 277001922 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209013987 Illinois

Profile Details

NPI number 1013370857
LBN Legal business name Jackson, Delovely Gloria
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 30th, 2016
Last updated May 8th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013370857 NPPES
Other F400298104 FPN MEDICARE PTAN

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