MEDICARE: JUANITA R SOUKOUNA REGISTERED NURSE

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	163W00000X	Registered Nurse	041312976	IL
2	163WC0400X	Case Management Registered Nurse	041-312976	IL

General Provider Information

NPI Number	:	1992829972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA R SOUKOUNA REGISTERED NURSE

Provider Business Mailing Address
First Line	:	9519 OAK PARK AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2136
Country	:	US
Telephone Number	:	708-675-0575
Fax Number	:	708-766-7812

Provider Business Practice Location Address
First Line	:	9519 OAK PARK AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2136
Country	:	US
Telephone Number	:	708-675-0575
Fax Number	:	708-430-8553

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	09/22/2025

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