MEDICARE: ELIZABETH NKANSAH

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	209.013177	IL

General Provider Information

NPI Number	:	1619346236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH NKANSAH

Provider Business Mailing Address
First Line	:	792 DELACOURTE AVE
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60490-5005
Country	:	US
Telephone Number	:	630-802-4636
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 N CICERO AVE STE 600
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5721
Country	:	US
Telephone Number	:	773-545-9200
Fax Number	:

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

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	02/15/2016

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