Jacqueline Therese Wirth, DNP, APRN, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209024208 Issued in IL

Practice address

1680 Mediterranean Dr Ste 107
Sycamore, IL 60178-3193

Phone

(815) 899-0001

NPI assigned

Dec 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Genesis Pediatric Medicine, LLC

  • Pediatrics Physician
  • Sycamore, IL
  • NPI 1912295494
  NPD (past)
• Lurie Children'S Medical Group, LLC

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1992758544
  NPD (past)

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

{
    "created_epoch": "1638835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1487312427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19304 MIDLAND AVE",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604481118",
            "telephone_number": "815-685-3572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 MEDITERRANEAN DR STE 107",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783193",
            "telephone_number": "815-899-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIRTH",
        "first_name": "JACQUELINE",
        "middle_name": "THERESE",
        "credential": "DNP, APRN, CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-07",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209024208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Williams, D.D.S.
• Sarah Williams, M.A.
• Alexa Anne Williamson
• Keelin Willits, NP-C
• Heather Winnan, D.C.
• Stephen C Withrow, PSYD
• WNKS, Inc.
• Jennifer Wolfe, RN, BSN SCHOOL NURSE
• Stephen L Woodrick, DDS
• Stacie Nichole Woodworth, ATC

• Pediatric Nurse Practitioner in Sycamore, IL
• Providers in Sycamore, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.