Jacqueline Rose Zdon, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

085-004090 Issued in IL

Practice address

4400 W 95TH St
Suite 205
Oak Lawn, IL 60453-2654

Phone

(708) 346-4040

Fax

(708) 346-3287

NPI assigned

Jul 28, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Jackie R Zdon Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329868800000",
    "number": "1003194796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 W 95TH ST",
            "address_2": "SUITE 205",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532654",
            "telephone_number": "708-346-4040",
            "fax_number": "708-346-3287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 W 95TH ST",
            "address_2": "SUITE 205",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532654",
            "telephone_number": "708-346-4040",
            "fax_number": "708-346-3287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZDON",
        "first_name": "JACQUELINE",
        "middle_name": "ROSE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-28",
        "last_updated": "2012-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085-004090",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "2832-023",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003194796",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "ZDON",
            "middle_name": "R",
            "prefix": "MISS",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Andreyna Alejandra Zaragoza
• Dominic Zarlengo, MD
• Diane Zawilinski
• Najla Atta Zayed, DO
• Sarah R Zayyad, PT,DPT
• Amanda Maureen Zeisel
• Deborah Zekich, DDS
• Nelly Zelaya, M.D.
• Allan B Zelinger, MD,FACC
• Natalia Zero, DO

• Surgical Physician Assistant in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.