MEDICARE: WINDY S. PLANETA APN-CNP

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
1	363LF0000X	Family Nurse Practitioner	209025866	IL
2	363L00000X	Nurse Practitioner	209.025866	IL

General Provider Information

NPI Number	:	1366163701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINDY S. PLANETA APN-CNP

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 W WINCHESTER RD STE 241
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-5360
Country	:	US
Telephone Number	:	847-549-0170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	05/06/2026

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