Healthcare Provider Details

I. General information

NPI: 1316151004
Provider Name (Legal Business Name): NORMA ROLFSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 S ELLIS AVE 4 KAPLAN
CHICAGO IL
60616-3395
US

IV. Provider business mailing address

5308 S HYDE PARK BLVD 3R
CHICAGO IL
60615-5737
US

V. Phone/Fax

Practice location:
  • Phone: 312-791-3455
  • Fax: 312-791-4158
Mailing address:
  • Phone: 312-791-3455
  • Fax: 312-791-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-245587
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-005298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: