Healthcare Provider Details

I. General information

NPI: 1578817003
Provider Name (Legal Business Name): IRMA E FUNES ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 GROSS POINT RD STE. 300
SKOKIE IL
60077-1886
US

IV. Provider business mailing address

5341 CAROL ST
SKOKIE IL
60077-2002
US

V. Phone/Fax

Practice location:
  • Phone: 847-965-1901
  • Fax: 847-965-1952
Mailing address:
  • Phone: 847-965-1901
  • Fax: 847-965-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009925
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-009925
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: