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General NPI Number Information
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NPI Number | 1548618085
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Entity Type | Individual
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Provider Name | ERIN PODGORNY MS APN AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 5801 S CASS AVE
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City | WESTMONT
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State | IL
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Zip | 60559-2300
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Country | US
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Telephone | 630-971-2645
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Fax |
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Provider Business Mailing Address
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Address Line | 24 W STATION ST UNIT 219
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City | PALATINE
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State | IL
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Zip | 60067-7602
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Country | US
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Telephone | 847-997-0142
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209014203
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License Number State | IL
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