Healthcare Provider Details

I. General information

NPI: 1942973334
Provider Name (Legal Business Name): YEONJUNG MOON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 08/07/2021
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MCHENRY RD
WHEELING IL
60090-3856
US

IV. Provider business mailing address

555 MCHENRY RD
WHEELING IL
60090-3856
US

V. Phone/Fax

Practice location:
  • Phone: 847-537-2900
  • Fax:
Mailing address:
  • Phone: 847-537-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041477225
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: