Healthcare Provider Details

I. General information

NPI: 1619346236
Provider Name (Legal Business Name): ELIZABETH NKANSAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N CICERO AVE STE 600
CHICAGO IL
60646-5721
US

IV. Provider business mailing address

792 DELACOURTE AVE
BOLINGBROOK IL
60490-5005
US

V. Phone/Fax

Practice location:
  • Phone: 773-545-9200
  • Fax:
Mailing address:
  • Phone: 630-802-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.013177
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: