Basic Information
| Provider Information | |||||||||
| NPI: | 1629427968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | EUNICE | ||||||||
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| Credential: | RN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 870 N MILWAUKEE AVE | ||||||||
| Address2: | |||||||||
| City: | VERNON HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600611521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474752273 | ||||||||
| FaxNumber: | 8475357761 | ||||||||
| Practice Location | |||||||||
| Address1: | 870 N MILWAUKEE AVE | ||||||||
| Address2: | |||||||||
| City: | VERNON HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600611521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474752273 | ||||||||
| FaxNumber: | 8475357761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2016 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209014307 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 209014307 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.