Individual
JACQUELINE THERESE WIRTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, CPNP-PC
Contact information
Practice address
1680 MEDITERRANEAN DR STE 107, SYCAMORE, IL 60178-3193
(815) 899-0001
Mailing address
19304 MIDLAND AVE, MOKENA, IL 60448-1118
(815) 685-3572
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209024208
IL
Other
Enumeration date
12/07/2021
Last updated
12/07/2021
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