Individual
MRS. JUCY TIESENGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
25 N WINFIELD RD STE 420, WINFIELD, IL 60190-1222
(630) 682-8700
(630) 352-5582
Mailing address
1880 W WINCHESTER RD STE 201, LIBERTYVILLE, IL 60048-5336
(847) 247-0187
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209009046
IL
363LA2200X
Adult Health Nurse Practitioner
209009046
IL
Other
Enumeration date
11/18/2011
Last updated
12/13/2021
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