Healthcare Provider Details

I. General information

NPI: 1659773455
Provider Name (Legal Business Name): JODI LYNN GUNTHER RN, APN-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD STE 610
ELK GROVE VILLAGE IL
60007-3362
US

IV. Provider business mailing address

800 BIESTERFIELD RD STE 610
ELK GROVE VILLAGE IL
60007-3362
US

V. Phone/Fax

Practice location:
  • Phone: 847-981-3630
  • Fax: 847-981-3626
Mailing address:
  • Phone: 847-981-3630
  • Fax: 847-981-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209.001594
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.219519
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: