Basic Information
| Provider Information | |||||||||
| NPI: | 1861826604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARRETT-RODNEY | ||||||||
| FirstName: | PAULETTE | ||||||||
| MiddleName: | Y. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JARRETT | ||||||||
| OtherFirstName: | PAULETTE | ||||||||
| OtherMiddleName: | Y. | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 271 SILVER LN | ||||||||
| Address2: | |||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601602536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083452505 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1649 N PULASKI RD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606395207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732786868 | ||||||||
| FaxNumber: | 7732786922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2013 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.010525 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 363LF0000X | 05 | IL | MEDICAID |