MEDICARE: ESSENTIAL HEALTHNP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1053022152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL HEALTHNP LLC

Provider Business Mailing Address
First Line	:	8833 S CRANDON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3051
Country	:	US
Telephone Number	:	312-590-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 E 93RD ST STE 339
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3916
Country	:	US
Telephone Number	:	312-590-1975
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE Q WILSON
Credential	:	APN
Telephone Number	:	312-590-1975

Provider Enumeration Date	:	12/09/2022
Last Update Date	:	04/21/2023

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Directions to “ESSENTIAL HEALTHNP LLC ” Practice Location

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