Healthcare Provider Details

I. General information

NPI: 1144613357
Provider Name (Legal Business Name): PAIGE ZIVIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W LAKE COOK RD SUITER 110
BUFFALO GROVE IL
60089-2089
US

IV. Provider business mailing address

600 W LAKE COOK RD SUITER 110
BUFFALO GROVE IL
60089-2089
US

V. Phone/Fax

Practice location:
  • Phone: 847-459-6611
  • Fax: 847-459-7929
Mailing address:
  • Phone: 847-459-6611
  • Fax: 847-459-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041369841
License Number StateIL

VIII. Authorized Official

Name: JILL SUTHERLAND
Title or Position: PRACTICE MANAGER
Credential:
Phone: 847-459-6611