MEDICARE: TATIANA ALEXEEV

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	163WP2201X	Ambulatory Care Registered Nurse	209013872	IL
2	363LA2200X	Adult Health Nurse Practitioner	277000101	IL
3	261QM2500X	Medical Specialty Clinic/Center	209013872	IL

General Provider Information

NPI Number	:	1902268410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA ALEXEEV

Provider Business Mailing Address
First Line	:	911 DIVISION ST
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-5087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3633 W LAKE AVE STE 303
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5803
Country	:	US
Telephone Number	:	224-432-5803
Fax Number	:

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	03/24/2020

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