Individual
LIDIYA M JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
12251 S 80TH AVE, PALOS HEIGHTS, IL 60463-1290
(630) 257-1111
(630) 257-1115
Mailing address
12251 S 80TH AVE, PALOS HEIGHTS, IL 60463-1290
(630) 257-1111
(630) 257-1115
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209021213
IL
Other
Enumeration date
04/23/2020
Last updated
12/30/2021
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