Healthcare Provider Details

I. General information

NPI: 1710477526
Provider Name (Legal Business Name): ELVIRA DZUBUR APN-CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9977 WOODS DR STE 100
SKOKIE IL
60077-1057
US

IV. Provider business mailing address

9977 WOODS DR STE 100
SKOKIE IL
60077-1057
US

V. Phone/Fax

Practice location:
  • Phone: 224-364-2273
  • Fax: 847-663-8290
Mailing address:
  • Phone: 224-364-2273
  • Fax: 847-663-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.016245
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209016245
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: