Active NPI
Jacqueline Petkovic, RN
- Registered Nurse
- Chicago, IL
National Provider Identifier
1053064741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 041.437627
- Practice address
- 355 E Erie St
Chicago, IL 60611-3167 - Phone
- (312) 238-2300
- NPI assigned
- Feb 2, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041.437627 | IL | Primary |
Addresses
Primary practice location
355 E Erie St
Chicago, IL 60611-3167
Mailing address
474 N Lake Shore Dr Apt 3505
Chicago, IL 60611-6478
Phone (847) 830-2229
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041.437627 | IL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643760000000",
"number": "1053064741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "474 N LAKE SHORE DR APT 3505",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606116478",
"telephone_number": "847-830-2229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "355 E ERIE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113167",
"telephone_number": "312-238-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETKOVIC",
"first_name": "JACQUELINE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-02",
"last_updated": "2022-02-02",
"certification_date": "2022-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041.437627",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.