Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036-111733 | IL |
Y | 2080P0210X | Pediatric Nephrologist | 3611473 | IL |
NPI | 1316146392 |
---|---|
Provider Name | Sara Elizabeth Jandeska |
First Address | Oak Park, IL 60302-2643 |
Second Address | Chicago, IL 60614-3363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 26/04/2021 |