Healthcare Provider Details

I. General information

NPI: 1902782121
Provider Name (Legal Business Name): IRENE BOROVKOV APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 GRAND AVE
GURNEE IL
60031-1651
US

IV. Provider business mailing address

6155 GRAND AVE
GURNEE IL
60031-1651
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7647
  • Fax: 847-535-8109
Mailing address:
  • Phone: 847-535-7647
  • Fax: 847-535-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209032732
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209032732
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: