Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209023950 | IL |
NPI | 1063166841 |
---|---|
Provider Name | Elizabeth Denisenko |
First Address | Northbrook, IL 60062-7158 |
Second Address | Oak Brook, IL 60523-1245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2022 |
Last Update Date | 09/02/2022 |