Healthcare Provider Details

I. General information

NPI: 1699959148
Provider Name (Legal Business Name): VIBE PEARL L GUILLERGAN-KUPSKI APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIBE PEARL L GUILLERGAN APRN-BC

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W TOUHY AVE
CHICAGO IL
60646-1100
US

IV. Provider business mailing address

90 SONOMA DR
ROMEOVILLE IL
60446-5166
US

V. Phone/Fax

Practice location:
  • Phone: 847-673-5166
  • Fax: 847-462-4411
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209006841
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209006841
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number41286442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: