Healthcare Provider Details

I. General information

NPI: 1083232474
Provider Name (Legal Business Name): CLINICIAN'S INCUBATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 OLD ORCHARD RD STE 300
SKOKIE IL
60077-4462
US

IV. Provider business mailing address

811 AUGUSTA RD
WILMINGTON DE
19807-2805
US

V. Phone/Fax

Practice location:
  • Phone: 888-536-2836
  • Fax:
Mailing address:
  • Phone: 302-893-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ABEL
Title or Position: PARTNER
Credential: LDN, CNS, MS, MA
Phone: 302-893-3801