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General NPI Number Information
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NPI Number | 1720327166
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Entity Type | Individual
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Provider Name | EILEEN L. MANOJLOVIC APN
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Gender | Female
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 2800 W 95TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2701
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Country | US
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Telephone | 708-229-5600
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Fax | 708-229-4105
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Provider Business Mailing Address
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Address Line | 2800 W 95TH STREET
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2735
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Country | US
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Telephone | 708-229-5600
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Fax | 708-229-4105
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.010117
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 28253213A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209010117
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License Number State | IL
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