MEDICARE: PROF. PAMELA SEMANIK CNP, APN, PHD

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	209-001494	IL
2	363LA2200X	Adult Health Nurse Practitioner	209-001494	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	248489523-00	OTHER		BWC OHIO

General Provider Information

NPI Number	:	1962410191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. PAMELA SEMANIK CNP, APN, PHD

Provider Business Mailing Address
First Line	:	1415 W FOSTER AVE
Second Line	:	GROUND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60640-2288
Country	:	US
Telephone Number	:	312-343-8372
Fax Number	:	708-406-1544

Provider Business Practice Location Address
First Line	:	1415 W FOSTER AVE
Second Line	:	GROUND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60640-2288
Country	:	US
Telephone Number	:	312-343-8372
Fax Number	:	708-406-1544

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	11/20/2013

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