Individual
MS. JESSICA A FANUCCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
4709 GOLF RD STE 900, SKOKIE, IL 60076
(847) 676-5394
(847) 679-7183
Mailing address
4709 GOLF RD STE 900, SKOKIE, IL 60076-1244
(847) 676-5394
(847) 679-7183
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209013322
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209.013322
LICENSED
IL
Enumeration date
11/20/2015
Last updated
04/27/2021
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