Healthcare Provider Details

I. General information

NPI: 1679750111
Provider Name (Legal Business Name): LUCIA S CHUNG APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 PARK AVE W HIGHLAND PARK HOSPITAL
HIGHLAND PARK IL
60035-2433
US

IV. Provider business mailing address

2650 RIDGE AVE EVANSTON NORTHWESTERN HEALTHCARE
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-5677
  • Fax: 847-657-5754
Mailing address:
  • Phone: 847-570-1644
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: