Healthcare Provider Details

I. General information

NPI: 1255941928
Provider Name (Legal Business Name): SAMANTHA KORNHAUSER APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PFINGSTEN RD STE 3000
GLENVIEW IL
60026-1314
US

IV. Provider business mailing address

2150 PFINGSTEN RD STE 3000
GLENVIEW IL
60026-1314
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-1700
  • Fax: 847-657-1715
Mailing address:
  • Phone: 847-657-1700
  • Fax: 847-657-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209019888
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.019888
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: