Active NPI
Jacquelyn Cooper
- Licensed Practical Nurse
- Hillside, IL
National Provider Identifier
1124667621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 043081911
- Practice address
- 230 N Lind Ave
Hillside, IL 60162-1538 - Phone
- (773) 587-0827
- NPI assigned
- Dec 31, 2019
- Last updated
- Dec 31, 2019
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 043081911 | IL | Primary |
Addresses
Primary practice location
230 N Lind Ave
Hillside, IL 60162-1538
Mailing address
230 N Lind Ave
Hillside, IL 60162-1538
Phone (773) 587-0827
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 043081911 | Medicaid | IL |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 043081911 | IL | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577750400000",
"number": "1124667621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 N LIND AVE",
"city": "HILLSIDE",
"state": "IL",
"postal_code": "601621538",
"telephone_number": "773-587-0827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 N LIND AVE",
"city": "HILLSIDE",
"state": "IL",
"postal_code": "601621538",
"telephone_number": "773-587-0827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "JACQUELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-31",
"last_updated": "2019-12-31",
"certification_date": "2019-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "IL",
"license": "043081911",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "043081911",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hillside, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.