Basic Information
| Provider Information | |||||||||
| NPI: | 1093932436 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | JUNE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | RN,APN,CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2740 W FOSTER AVE | ||||||||
| Address2: | STE LL7 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606253543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738788200 | ||||||||
| FaxNumber: | 1760432348 | ||||||||
| Practice Location | |||||||||
| Address1: | 5215 N CALIFORNIA AVE STE 600 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606258564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739896222 | ||||||||
| FaxNumber: | 7739891734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2100X | 209-002512 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Acute Care | 367500000X | 209002512 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 363L00000X | 209002512 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163WP0000X | 209002512 | IL | N | Nursing Service Providers | Registered Nurse | Pain Management | 364S00000X | 209002512 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
ID Information
| ID | Type | State | Issuer | Description | F400270461 | 01 | IL | MIEDICARE PTAN | OTHER |