Healthcare Provider Details

I. General information

NPI: 1508585993
Provider Name (Legal Business Name): ASSUMPTA E IKE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 RIDGE RD
LANSING IL
60438-3102
US

IV. Provider business mailing address

20000 CYPRESS AVE
LYNWOOD IL
60411-6836
US

V. Phone/Fax

Practice location:
  • Phone: 708-858-6132
  • Fax:
Mailing address:
  • Phone: 708-717-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number015350
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: