Healthcare Provider Details

I. General information

NPI: 1326460601
Provider Name (Legal Business Name): GANKA SKERLEVA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W DEVON AVE
CHICAGO IL
60660-1302
US

IV. Provider business mailing address

1300 W DEVON AVE
CHICAGO IL
60660-1302
US

V. Phone/Fax

Practice location:
  • Phone: 773-751-7850
  • Fax: 773-751-7855
Mailing address:
  • Phone: 773-751-7850
  • Fax: 773-751-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010938
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: