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Jackson Paul Tate
Student in an Organized Health Care Education/Training Program in Oak Park, Illinois
NPI 1164207031

Jackson Paul Tate is a Student in an Organized Health Care Education/Training Program based in Oak Park, IL. Jackson Paul Tate practices in Oak Park, IL. The NPI Number for Jackson Paul Tate is 1164207031 and holds a License No. (Illinois).

The current practice location address for Jackson Paul Tate is 504 S Cuyler Ave Apt 11, Oak Park, IL and can be reached out via phone at 530-401-7851.

Location: 504 S Cuyler Ave Apt 11, Oak Park, IL, 60304-1542
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1164207031
Provider Name
Jackson Paul Tate
Credential
Provider Entity Type
Individual
Gender
Male
Address
504 S Cuyler Ave Apt 11, Oak Park, IL, 60304-1542
Phone Number
530-401-7851
Fax Number
Provider Enumeration Date
08/29/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
504 S Cuyler Ave Apt 11
City
Oak Park
State
Illinois
Zip
60304-1542
Phone Number
530-401-7851
Fax Number
person
Provider Business Mailing Address Details
Address
504 S Cuyler Ave Apt 11
City
Oak Park
State
Illinois
Zip
60304-1542
Phone Number
530-401-7851
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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