Healthcare Provider Details

I. General information

NPI: 1831638089
Provider Name (Legal Business Name): ELIZABETH SIMKUS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

556 JEFFERSON ST
HINSDALE IL
60521-3843
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-4444
  • Fax: 312-563-2775
Mailing address:
  • Phone: 312-618-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041388783
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.015575
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: