Healthcare Provider Details

I. General information

NPI: 1336971845
Provider Name (Legal Business Name): ELISABETH VENERUS DNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISABETH FREDRICKSON

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 20-150
CHICAGO IL
60611-5979
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 20-150
CHICAGO IL
60611-5979
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8146
  • Fax: 312-695-7030
Mailing address:
  • Phone: 312-695-8146
  • Fax: 312-695-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209030433
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209030433
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041454866
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: