Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
NICOLE M. JACK, PA-C
ActiveNICOLE M. JACK, PA-C is a Physician Assistant healthcare provider located in PONTIAC, Illinois. NPI 1083104137 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · PONTIAC, IL
Registration Details
- NPI Number
- 1083104137
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- May 15, 2018 (8.4600205922261 yrs)
- Last Updated
- Jun 18, 2018
- License
-
085006579 (IL)
Practice Information
- Address
-
2500 W REYNOLDS STPONTIAC, IL, 61764Browse IL providers · Browse ZIP 61764
- Phone
- 8158445343
- Fax
- 8158445715
- Primary Specialty
-
Physician Assistant
363A00000X
Other Physician Assistant Providers in PONTIAC, IL
| Name | Credential | NPI |
|---|---|---|
| JOHN KINCINAS | PA | 1477572154 |
| MICHELE E MASCHING-WRIGHT | PA-C | 1194830695 |
| RICHARD SAYLOR | — | 1316030679 |
| LESLIE ROMERSBERGER | — | 1104153550 |
| WILLIAM LEE CHANG II | — | 1023326121 |
| DANIELLE VANDERVEEN | — | 1215235007 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.