Healthcare Provider Details

I. General information

NPI: 1588367486
Provider Name (Legal Business Name): YUNIELL BETANCOURT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E WOODFIELD RD STE 300
SCHAUMBURG IL
60173-4776
US

IV. Provider business mailing address

804 E WOODFIELD RD STE 300
SCHAUMBURG IL
60173-4776
US

V. Phone/Fax

Practice location:
  • Phone: 847-605-9500
  • Fax: 847-605-8700
Mailing address:
  • Phone: 847-605-9500
  • Fax: 847-605-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.026652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: