Individual
MISS JACQUELINE ROSE ZDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4400 W 95TH ST, SUITE 205, OAK LAWN, IL 60453-2654
(708) 346-4040
(708) 346-3287
Mailing address
4400 W 95TH ST, SUITE 205, OAK LAWN, IL 60453-2654
(708) 346-4040
(708) 346-3287
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085-004090
IL
363AS0400X
Surgical Physician Assistant
2832-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003194796
—
WI
Enumeration date
07/28/2011
Last updated
02/22/2012
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