Healthcare Provider Details

I. General information

NPI: 1982107322
Provider Name (Legal Business Name): GENEVIEVE ANNE WALDSCHMIDT FPA-APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 27TH ST
ZION IL
60099-2542
US

IV. Provider business mailing address

1911 27TH ST
ZION IL
60099-2542
US

V. Phone/Fax

Practice location:
  • Phone: 847-377-8800
  • Fax: 847-984-5619
Mailing address:
  • Phone: 847-377-8382
  • Fax: 847-984-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001957
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: