Healthcare Provider Details

I. General information

NPI: 1093843542
Provider Name (Legal Business Name): KRISTIN J ELWART APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

840 S WOOD ST MC 856
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6605
  • Fax: 312-413-3373
Mailing address:
  • Phone: 312-996-6605
  • Fax: 312-413-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number277000731
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277000731
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: