MEDICARE: NATALYA KUZENKOVA 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
1	363LF0000X	Family Nurse Practitioner	209016300	IL

General Provider Information

NPI Number	:	1487170957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALYA KUZENKOVA APN

Provider Business Mailing Address
First Line	:	850 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3077
Country	:	US
Telephone Number	:	773-525-6780
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2520
Country	:	US
Telephone Number	:	773-784-0900
Fax Number	:

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

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	08/16/2017

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