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NPI Code Detail

MEDICARE: GENEVIEVE SAN NICOLAS APRN, AGACNP-BC, DNP

MEDICARE: GENEVIEVE SAN NICOLAS APRN, AGACNP-BC, DNP
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
1363L00000XNurse Practitioner209032944IL
2363LC0200XCritical Care Medicine Nurse Practitioner9363062FL
3363LF0000XFamily Nurse Practitioner9363092FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174090500
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENEVIEVE SAN NICOLAS APRN, AGACNP-BC, DNP
Provider Business Mailing Address
First Line : 251 E HURON ST STE 5-704
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2908
Country : US
Telephone Number : 312-695-0061
Fax Number : 312-926-8341
Provider Business Practice Location Address
First Line : 251 E HURON ST STE 5-704
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2908
Country : US
Telephone Number : 312-695-0061
Fax Number : 312-926-8341
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2018
Last Update Date : 12/19/2025

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Directions to “ GENEVIEVE SAN NICOLAS APRN, AGACNP-BC, DNP” Practice Location

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