Healthcare Provider Details

I. General information

NPI: 1306482187
Provider Name (Legal Business Name): NATASHA OBRADOVIC APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E DUNDEE RD
BUFFALO GROVE IL
60089-4384
US

IV. Provider business mailing address

20 E DUNDEE RD
BUFFALO GROVE IL
60089-4384
US

V. Phone/Fax

Practice location:
  • Phone: 847-459-3800
  • Fax:
Mailing address:
  • Phone: 847-459-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019396
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: