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General NPI Number Information
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NPI Number | 1619434420
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Entity Type | Organization
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Legal Business Name | ELITE PRACTITIONER LLC
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 151 N MICHIGAN AVE STE 210
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City | CHICAGO
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State | IL
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Zip | 60601-7506
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Country | US
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Telephone | 773-299-4804
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Fax |
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Provider Business Mailing Address
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Address Line | 151 N MICHIGAN AVE STE 210
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City | CHICAGO
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State | IL
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Zip | 60601-7506
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Country | US
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Telephone | 773-299-8404
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE NURSE OFFICER
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Name | MISS EMEM T. OBOT
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Credential | FNP-C
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Telephone | 773-299-4804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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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 |
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License Number State |
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