Healthcare Provider Details

I. General information

NPI: 1912438623
Provider Name (Legal Business Name): KRISTINE CUARESMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WESTMORELAND RD
LAKE FOREST IL
60045-1658
US

IV. Provider business mailing address

5368 N LOWELL AVE
CHICAGO IL
60630-1736
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7600
  • Fax:
Mailing address:
  • Phone: 224-622-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209015807
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209015807
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209015807
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: