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Provider Information for 1134766132

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1134766132

Calendar   Last Updated:  2020-11-13
  Certification Date:  2020-11-13


Name Value
NPI 1134766132
Enumeration Date 2019-12-09
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 W NORTH AVE APT 308
CHICAGO, IL 60610-1259
United States

Phone: 312-437-1023 | Fax:
View Map External Link
Primary Practice Address 1969 W OGDEN AVE
CHICAGO, IL 60612-3765
United States

Phone: 312-864-6000 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family IL 209020470