Healthcare Provider Details

I. General information

NPI: 1992829972
Provider Name (Legal Business Name): JUANITA R SOUKOUNA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9519 OAK PARK AVE
OAK LAWN IL
60453-2136
US

IV. Provider business mailing address

9519 OAK PARK AVE
OAK LAWN IL
60453-2136
US

V. Phone/Fax

Practice location:
  • Phone: 708-675-0575
  • Fax: 708-430-8553
Mailing address:
  • Phone: 708-675-0575
  • Fax: 708-766-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041312976
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041-312976
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: