Individual
DELOVELY GLORIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1400 OTTO BLVD, CHICAGO HEIGHTS, IL 60411-3741
(708) 733-7200
(708) 733-7222
Mailing address
35318 EAGLE WAY, CHICAGO, IL 60678-0353
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209013987
IL
363LF0000X
Family Nurse Practitioner
277001922
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400298104
FPN MEDICARE PTAN
—
Enumeration date
03/30/2016
Last updated
05/08/2023
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