Healthcare Provider Details

I. General information

NPI: 1144469917
Provider Name (Legal Business Name): ELIZABETH M WENGEL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 W AUGUSTA BLVD STE 1
CHICAGO IL
60642-4327
US

IV. Provider business mailing address

1203 W AUGUSTA BLVD STE 1
CHICAGO IL
60642-4327
US

V. Phone/Fax

Practice location:
  • Phone: 773-248-2255
  • Fax: 773-524-2466
Mailing address:
  • Phone: 773-248-2255
  • Fax: 773-524-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007454
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209007454
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: