Healthcare Provider Details

I. General information

NPI: 1841012457
Provider Name (Legal Business Name): LINA GUDAUSKAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 W WINCHESTER RD # 1770
LIBERTYVILLE IL
60048-5341
US

IV. Provider business mailing address

1880 W WINCHESTER RD STE 1770
LIBERTYVILLE IL
60048-5341
US

V. Phone/Fax

Practice location:
  • Phone: 947-968-2401
  • Fax:
Mailing address:
  • Phone: 847-968-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2023063756
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: