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General NPI Number Information
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NPI Number | 1346746591
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Entity Type | Individual
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Provider Name | KRYS ELAN CAGAS
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Gender | Female
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 666 DUNDEE RD STE 802
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City | NORTHBROOK
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State | IL
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Zip | 60062-2734
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Country | US
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Telephone | 847-498-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 114 GLENWOOD DR
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City | ROUND LAKE BEACH
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State | IL
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Zip | 60073-2624
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.387249
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.017230
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License Number State | IL
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