Basic Information
| Provider Information | |||||||||
| NPI: | 1861008021 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELIZABETH Z GUSSIS, APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 313 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | WEST DUNDEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601182225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2246999252 | ||||||||
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| Practice Location | |||||||||
| Address1: | 551 TOLLGATE ROAD SUITE A | ||||||||
| Address2: | A | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601236012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2248028824 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2020 | ||||||||
| LastUpdateDate: | 11/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUSSIS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2246999252 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APN FPA | ||||||||
| NPICertificationDate: | 10/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.