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General NPI Number Information
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NPI Number | 1952704116
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Entity Type | Individual
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Provider Name | JANETTE QUERUBIN
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Gender | Female
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 2233 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-8151
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Country | US
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Telephone | 312-770-1594
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 N MOZART ST
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City | CHICAGO
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State | IL
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Zip | 60622-2715
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Country | US
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Telephone | 312-451-6461
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209011941
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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 | 209011941
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License Number State | IL
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