Healthcare Provider Details

I. General information

NPI: 1093640922
Provider Name (Legal Business Name): SAMANTHA BERKSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WESTMORELAND RD
LAKE FOREST IL
60045-1658
US

IV. Provider business mailing address

1738 N MOHAWK ST APT 2
CHICAGO IL
60614-6611
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-5600
  • Fax:
Mailing address:
  • Phone: 847-347-6787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.033998
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: