Healthcare Provider Details

I. General information

NPI: 1740158690
Provider Name (Legal Business Name): KRISTINE IVY POL GUMAPAS MSN, AGACNP-BC, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DAVIS ST
EVANSTON IL
60201-3683
US

IV. Provider business mailing address

1819 N SAINT LOUIS AVE APT 1RS
CHICAGO IL
60647-2261
US

V. Phone/Fax

Practice location:
  • Phone: 224-487-4624
  • Fax:
Mailing address:
  • Phone: 773-512-3641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209027420
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: