Individual
CYNTHIA ANN JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2300 N ROCKTON AVE, ROCKFORD, IL 61103-3619
(815) 971-2000
Mailing address
2300 N ROCKTON AVE, ROCKFORD, IL 61103-3619
(815) 971-2000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.009900
IL
363LX0106X
Occupational Health Nurse Practitioner
209009900
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710222807
—
WI
01
—
209.009900
STATE OF ILLINOIS LICENSE
IL
Enumeration date
11/30/2012
Last updated
09/18/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us