MEDICARE: JANETTE P QUERUBIN 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	363L00000X	Nurse Practitioner	209011941	IL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277003549	IL
3	363LG0600X	Gerontology Nurse Practitioner	209011941	IL

General Provider Information

NPI Number	:	1952704116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANETTE P QUERUBIN APN-CNP

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE # 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-982-3175
Fax Number	:	847-982-3394

Provider Business Practice Location Address
First Line	:	5145 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3661
Country	:	US
Telephone Number	:	847-570-1027
Fax Number	:	773-989-1734

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

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	05/12/2026

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