Healthcare Provider Details

I. General information

NPI: 1437494630
Provider Name (Legal Business Name): TAMMY L DUBOSE APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 10/08/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE DEPARTMENT OF PSYCHIATRY
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

2620 RIDGE AVE. DEPARTMENT OF PSYCHIATRY
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-432-5464
  • Fax: 847-425-6408
Mailing address:
  • Phone: 847-432-5464
  • Fax: 847-425-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277005866
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209028247
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: