MEDICARE: MRS. KRISTINA B PASSARELLI APN-CNP

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	363LF0000X	Family Nurse Practitioner	209007392	IL
2	363L00000X	Nurse Practitioner	209007392	IL

General Provider Information

NPI Number	:	1942445234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA B PASSARELLI APN-CNP

Provider Business Mailing Address
First Line	:	9977 WOODS DR STE 100
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-1057
Country	:	US
Telephone Number	:	224-364-2273
Fax Number	:	847-663-8290

Provider Business Practice Location Address
First Line	:	990 GRAND CANYON PKWY STE 218
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1735
Country	:	US
Telephone Number	:	630-283-0314
Fax Number	:	224-353-6445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	03/20/2023

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