Provider Demographics
NPI:1194338145
Name:ELATKIN, KRISTIN D (NP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:ELATKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 SIGWALT ST
Mailing Address - Street 2:
Mailing Address - City:ROLLING MDWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1473
Mailing Address - Country:US
Mailing Address - Phone:847-338-7384
Mailing Address - Fax:
Practice Address - Street 1:9139 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1303
Practice Address - Country:US
Practice Address - Phone:708-387-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020121363L00000X
IL209-020121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner