| Longevity Clinical Ltc Associates Of Illinois Pllc | |
|
6300 N California Ave Chicago IL 60659-1702 | |
| (773) 973-1900 | |
| Not Available |
| Full Name | Longevity Clinical Ltc Associates Of Illinois Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 6300 N California Ave, Chicago, Illinois |
| Authorized Official Name and Position | Diane Vincur (CLINICAL SUPPORT TALENT SPECIALIST) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Clinical Ltc Associates Of Illinois Pllc 11770 Us Highway 1 Ste 102e Palm Beach Gardens FL 33408-3052 Ph: (561) 444-0788 | Longevity Clinical Ltc Associates Of Illinois Pllc 6300 N California Ave Chicago IL 60659-1702 Ph: (773) 973-1900 |
| NPI Number | 1407422447 |
|---|---|
| Provider Enumeration Date | 06/01/2021 |
| Last Update Date | 06/01/2021 |
| Medicare PECOS PAC ID | 7012313919 |
|---|---|
| Medicare Enrollment ID | O20210901000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407422447 | NPI | - | NPPES |
| Provider Name | Cailian Mo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285172643 PECOS PAC ID: 5597040832 Enrollment ID: I20170328002378 |
| Provider Name | Kimberly J Grzesik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407381296 PECOS PAC ID: 1850664343 Enrollment ID: I20170905002626 |
| Provider Name | Heather A Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255856894 PECOS PAC ID: 4284908732 Enrollment ID: I20170921001655 |
| Provider Name | Lynn St Victor Luckett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114438249 PECOS PAC ID: 0345508198 Enrollment ID: I20171227002057 |
| Provider Name | Mary Jeane R Velez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073084497 PECOS PAC ID: 5294073672 Enrollment ID: I20190211000026 |
| Provider Name | Nikita Sarath Gummadi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770057440 PECOS PAC ID: 8729326954 Enrollment ID: I20190214000917 |
| Provider Name | Sisenia Cortes Salinas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548819808 PECOS PAC ID: 2567793870 Enrollment ID: I20191016003506 |
| Provider Name | Melissa Nancy Day |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740830777 PECOS PAC ID: 7810325214 Enrollment ID: I20200318001624 |
| Provider Name | Krutikaben V Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861013823 PECOS PAC ID: 7113343765 Enrollment ID: I20200813002224 |
| Provider Name | Viktoriya Rouse-freeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932747078 PECOS PAC ID: 8729479944 Enrollment ID: I20211223001506 |
| Provider Name | Nicole Marie Floress |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396597589 PECOS PAC ID: 5092156711 Enrollment ID: I20240513002782 |
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