Healthcare Provider Details

I. General information

NPI: 1336036029
Provider Name (Legal Business Name): ELENA CAUNCA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA ELENA TOLENTINO CAUNCA RN

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

849 W LELAND AVE UNIT 2E
CHICAGO IL
60640-8689
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041315671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: