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General NPI Number Information
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NPI Number | 1114298692
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Entity Type | Organization
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Legal Business Name | TOTAL JOINT VENTURE LLC
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 1415 W FOSTER AVE GROUND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60640-2288
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Country | US
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Telephone | 312-343-8372
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Fax | 708-406-1544
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Provider Business Mailing Address
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Address Line | 1415 W FOSTER AVE GROUND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60640-2288
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | PAMELA A SEMANIK
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Credential | PHD APN
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Telephone | 312-343-8372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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