Healthcare Provider Details

I. General information

NPI: 1043778731
Provider Name (Legal Business Name): KRISTIN ROSE LUCENTE APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN ROSE NELSON APN-CNP

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST
CHICAGO IL
60642-2605
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-3590
  • Fax: 847-618-0305
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number277003854
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277003854
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277003854
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: