Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036099358 | IL |
N | 207ND0900X | Dermatopathologist | 036099358 | IL |
NPI | 1487643334 |
---|---|
Provider Name | Joy Darlene Jester |
First Address | Chicago, IL 60674-2426 |
Second Address | Tinley Park, IL 60487-7581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 12/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036099358 | (05) | IL |
070015439 | RAILROAD MEDICARE (01) | IL |
E57734 | (02) | IL |