MEDICARE: RUVINI DEVAS GUNAWARDHANE 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	209.011230	IL
2	363L00000X	Nurse Practitioner	209011230	IL

General Provider Information

NPI Number	:	1609230606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUVINI DEVAS GUNAWARDHANE APN-CNP

Provider Business Mailing Address
First Line	:	1122 WILLOW RD
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-6824
Country	:	US
Telephone Number	:	847-686-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 WILLOW RD
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-6824
Country	:	US
Telephone Number	:	847-686-4444
Fax Number	:

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

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	04/06/2026

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Directions to “ RUVINI DEVAS GUNAWARDHANE APN-CNP” Practice Location

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