Individual
JACLYN MARY PETROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
10260 191ST ST STE 100, MOKENA, IL 60448-8802
(708) 572-7669
(708) 422-4253
Mailing address
10260 191ST ST STE 100, MOKENA, IL 60448-8802
(708) 572-7669
(708) 422-4253
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
209.019158
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209.019158
APN LICENSE
IL
Enumeration date
04/26/2019
Last updated
09/28/2022
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