Healthcare Provider Details

I. General information

NPI: 1316357031
Provider Name (Legal Business Name): ROSS DUERKSEN RN, MSN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE #821
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1725 W HARRISON ST SUITE 821
CHICAGO IL
60612-3841
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-2320
  • Fax:
Mailing address:
  • Phone: 312-563-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.011453
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: