Healthcare Provider Details

I. General information

NPI: 1427756188
Provider Name (Legal Business Name): JUDY METROPULOS APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 E BELVIDERE RD STE 311
GRAYSLAKE IL
60030-2016
US

IV. Provider business mailing address

1475 E BELVIDERE RD STE 311
GRAYSLAKE IL
60030-2016
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-6083
  • Fax: 312-694-0039
Mailing address:
  • Phone: 847-535-6083
  • Fax: 312-694-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027086
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: