Healthcare Provider Details

I. General information

NPI: 1801382510
Provider Name (Legal Business Name): ERIKA JANG APRN, CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 06/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 S WENTWORTH AVE
CHICAGO IL
60616-4615
US

IV. Provider business mailing address

2323 S WENTWORTH AVE
CHICAGO IL
60616-4615
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-2900
  • Fax: 312-842-0100
Mailing address:
  • Phone: 312-567-2900
  • Fax: 312-842-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209017947
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number209017947
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: