Healthcare Provider Details

I. General information

NPI: 1528055225
Provider Name (Legal Business Name): CHRISTINE M LUKANICH CNM/WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17850 KEDZIE AVE STE 1500
HAZEL CREST IL
60429-2055
US

IV. Provider business mailing address

1860 PAYSHERE CIRCLE
CHICAGO IL
60674-0001
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-7780
  • Fax: 708-433-2730
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209000111
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: