Healthcare Provider Details

I. General information

NPI: 1528538444
Provider Name (Legal Business Name): NICOLE C. ERDENEKHUYAG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N SHEFFIELD AVE STE C
CHICAGO IL
60657-7231
US

IV. Provider business mailing address

4116 N SPAULDING AVE APT 1
CHICAGO IL
60618-4090
US

V. Phone/Fax

Practice location:
  • Phone: 630-912-8462
  • Fax: 833-602-1648
Mailing address:
  • Phone: 773-318-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: