Healthcare Provider Details

I. General information

NPI: 1750279055
Provider Name (Legal Business Name): MRS. EVA DUNDROVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24647 N MILWAUKEE AVE
VERNON HILLS IL
60061-1567
US

IV. Provider business mailing address

642 HERMITAGE DR
DEERFIELD IL
60015-4447
US

V. Phone/Fax

Practice location:
  • Phone: 847-377-7950
  • Fax:
Mailing address:
  • Phone: 240-643-1803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number041373607
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: