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General NPI Number Information
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NPI Number | 1598296568
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Entity Type | Organization
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Legal Business Name | ENDEAVOR CLINICAL HEALTH CARE SERVICES
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 10611 S LOWE AVE
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City | CHICAGO
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State | IL
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Zip | 60628-2311
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Country | US
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Telephone | 773-405-8076
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Fax |
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Provider Business Mailing Address
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Address Line | 10611 S LOWE AVE
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City | CHICAGO
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State | IL
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Zip | 60628-2311
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Country | US
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Telephone | 773-405-8076
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITONER
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Name | PATRICIA VOWAL
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Credential |
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Telephone | 773-405-8076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209-011276
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License Number State | IL
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