Healthcare Provider Details

I. General information

NPI: 1790468866
Provider Name (Legal Business Name): KARINA COVARRUBIAS GORGEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

2828 N TALMAN AVE
CHICAGO IL
60618-7846
US

V. Phone/Fax

Practice location:
  • Phone: 312-947-1150
  • Fax:
Mailing address:
  • Phone: 773-916-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209033742
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041438083
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: