Provider Demographics
NPI:1689945339
Name:JANKOWSKI, LACI CHRISTINE (APN)
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:CHRISTINE
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 W LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1349
Mailing Address - Country:US
Mailing Address - Phone:618-521-1657
Mailing Address - Fax:
Practice Address - Street 1:1501 MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2831
Practice Address - Country:US
Practice Address - Phone:618-241-1360
Practice Address - Fax:618-241-1865
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-398735363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-398735OtherSTATE OF ILLINOIS LICENSES NUMBER