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Organization
TARGET CLINIC
Active
Organization
TARGET CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH MARIE JACOBSMA APN, FNP-C (NURSE PRACTITIONER)
(563) 505-3837
Entity
Organization
Contact information
Practice address
1154 S CLARK ST, CHICAGO, IL 60605-2159
(312) 212-6300
Mailing address
4733 N CLARK ST, APT 2N, CHICAGO, IL 60640-7555
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
209010998
IL
Other
Enumeration date
11/18/2013
Last updated
11/19/2013
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