MISS JACQUELINE ROSE ZDON PA-C NPI 1003194796

NPI Information

NPI: 1003194796
Provider Name: MISS JACQUELINE ROSE ZDON, PA-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

Address:
4400 W 95TH ST
SUITE 205
OAK LAWN, IL
ZIP 60453
Phone: (708) 346-4040
Get Directions

MISS Jacqueline Rose Zdon, PA-C is a surgical physician assistant in Oak Lawn, IL. MISS Jacqueline Rose Zdon, PA-C NPI is 1003194796. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4400 W 95TH ST
SUITE 205
OAK LAWN, IL
ZIP 60453-654
Phone: (708) 346-4040
Fax: (708) 346-3287

The enumeration date for this NPI number is 7/28/2011 and was last updated on 2/22/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	2832-023	WISCONSIN	No
2	363AS0400X	Physician Assistant	Surgical	085-004090	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1003194796	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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