Individual provider · NPI-1

Jaclyn Mary Petrov, APN

Nurse Practitioner, Obstetrics & Gynecology · Mokena, IL

NPI number1295399178
StatusActive
Last updated in NPPESSep 28, 2022

Details

NPI
1295399178
Entity type
Individual (NPI-1)
Name
Jaclyn Mary Petrov
Credential
APN
Sex
Female
Sole proprietor
No
Enumeration date
Apr 26, 2019
Certification date
Sep 28, 2022
Last updated
Sep 28, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LX0001X Nurse Practitioner, Obstetrics & Gynecology209.019158INYes

Other names

  • Jaclyn Mary Serafin (Former Name)

Practice location

10260 191st St Ste 100
Mokena, IL 60448-8802

Phone 708-572-7669 · Fax 708-422-4253

Mailing address

10260 191st St Ste 100
Mokena, IL 60448-8802

Phone 708-572-7669 · Fax 708-422-4253

Other practice locations

9730 S Western Ave
Evergreen Park, IL 60805-2814

Phone 708-425-1907 · Fax 708-422-4253

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