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NPI Code Detail

MEDICARE: ELIZABETH M WENGEL APN

MEDICARE: ELIZABETH M WENGEL APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209007454IL
2363LP0808XPsychiatric/Mental Health Nurse Practitioner209007454IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1206147OTHERILMEDICARE GROUP
2F400450938OTHERILMEDICARE INDIVIDUAL

General Provider Information

NPI Number : 1144469917
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH M WENGEL APN
Provider Business Mailing Address
First Line : 1203 W AUGUSTA BLVD STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60642-4327
Country : US
Telephone Number : 773-248-2255
Fax Number : 773-524-2466
Provider Business Practice Location Address
First Line : 1203 W AUGUSTA BLVD STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60642-4327
Country : US
Telephone Number : 773-248-2255
Fax Number : 773-524-2466
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2009
Last Update Date : 11/14/2025

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