Active NPI
Joann F Petty, APN CNS
- Oncology Clinical Nurse Specialist
- Warrenville, IL
National Provider Identifier
1780889626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oncology Clinical Nurse Specialist
- License
- 209004957
- Practice address
- 4405 Weaver Pkwy
Warrenville, IL 60555-3269 - Phone
- (630) 352-5300
- Fax
- (630) 352-5499
- NPI assigned
- Jun 20, 2007
- 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 |
|---|---|---|---|---|
| Oncology Clinical Nurse Specialist | 364SX0200X | 209004957 | IL | Primary |
Addresses
Primary practice location
4405 Weaver Pkwy
Warrenville, IL 60555-3269
Mailing address
4405 Weaver Pkwy
Warrenville, IL 60555-3269
Phone (630) 352-5300
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 206147075 | Other | IL | MEDICARE PTAN (INDIVIDUAL) |
| CA4748 | Other | IL | MEDICARE RAILROAD PTAN (GROUP) |
| 206147 | Other | IL | MEDICARE PTAN (GROUP) |
| P01013439 | Other | IL | MEDICARE RAILROAD PTAN (INDIVIDUAL) |
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)
- Enrolled
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209004957 | IL | MD | Oncology Clinical Nurse Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illinois Cancer Specialists | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Hematology & Oncology Physician
- Niles, IL
- NPI 1164483913
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368835200000",
"number": "1780889626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4405 WEAVER PKWY",
"city": "WARRENVILLE",
"state": "IL",
"postal_code": "605553269",
"telephone_number": "630-352-5300",
"fax_number": "630-352-5499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4405 WEAVER PKWY",
"city": "WARRENVILLE",
"state": "IL",
"postal_code": "605553269",
"telephone_number": "630-352-5300",
"fax_number": "630-352-5499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "JOANN",
"middle_name": "F",
"credential": "APN CNS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-20",
"last_updated": "2013-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "364SX0200X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Oncology",
"state": "IL",
"license": "209004957",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN (INDIVIDUAL)",
"identifier": "206147075",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD PTAN (GROUP)",
"identifier": "CA4748",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN (GROUP)",
"identifier": "206147",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD PTAN (INDIVIDUAL)",
"identifier": "P01013439",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warrenville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.