Healthcare Provider Details

I. General information

NPI: 1902524093
Provider Name (Legal Business Name): BRANKA LUGONJA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 W ADAMS ST STE 205
CHICAGO IL
60661-5748
US

IV. Provider business mailing address

566 W ADAMS ST STE 205
CHICAGO IL
60661-5748
US

V. Phone/Fax

Practice location:
  • Phone: 773-572-1843
  • Fax:
Mailing address:
  • Phone: 773-572-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.025608
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10471-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: