Healthcare Provider Details

I. General information

NPI: 1013853928
Provider Name (Legal Business Name): AMBER LULLO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BIESTERFIELD RD STE 105
ELK GROVE VILLAGE IL
60007-3393
US

IV. Provider business mailing address

PO BOX 340
AROMA PARK IL
60910-0340
US

V. Phone/Fax

Practice location:
  • Phone: 847-228-9898
  • Fax:
Mailing address:
  • Phone: 815-295-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209034650
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: