Healthcare Provider Details

I. General information

NPI: 1265246144
Provider Name (Legal Business Name): ENKHTUYA GELEGDORJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 HANBURY DR
DES PLAINES IL
60016-1567
US

IV. Provider business mailing address

706 HANBURY DR
DES PLAINES IL
60016-1567
US

V. Phone/Fax

Practice location:
  • Phone: 773-540-6561
  • Fax:
Mailing address:
  • Phone: 773-540-6561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209031550
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: