Provider Demographics
NPI:1104295666
Name:JANNUSCH, ELIZABETH (FNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:JANNUSCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:INGEBRIGTSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1860 PAYSHERE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0001
Mailing Address - Country:US
Mailing Address - Phone:630-545-6016
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:BROCK STE 4011
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3694
Practice Address - Fax:847-981-6508
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily