Healthcare Provider Details

I. General information

NPI: 1255869145
Provider Name (Legal Business Name): ELIZABETH UNVERRICHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S RIVERSIDE PLZ
CHICAGO IL
60606-5808
US

IV. Provider business mailing address

222 S RIVERSIDE PLZ STE 860
CHICAGO IL
60606-5900
US

V. Phone/Fax

Practice location:
  • Phone: 312-416-3804
  • Fax:
Mailing address:
  • Phone: 312-416-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number041221004
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: