Healthcare Provider Details

I. General information

NPI: 1932094513
Provider Name (Legal Business Name): JULIANNE KHANINA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 N GENESEE ST
WAUKEGAN IL
60085-4262
US

IV. Provider business mailing address

5680 MIDDLEBURY LN
GURNEE IL
60031-2063
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209032266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: