Provider Demographics
NPI:1962410191
Name:SEMANIK, PAMELA (CNP, APN, PHD)
Entity type:Individual
Prefix:PROF
First Name:PAMELA
Middle Name:
Last Name:SEMANIK
Suffix:
Gender:F
Credentials:CNP, APN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 W FOSTER AVE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2288
Mailing Address - Country:US
Mailing Address - Phone:312-343-8372
Mailing Address - Fax:708-406-1544
Practice Address - Street 1:1415 W FOSTER AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2288
Practice Address - Country:US
Practice Address - Phone:312-343-8372
Practice Address - Fax:708-406-1544
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001494363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
248489523-00OtherBWC OHIO
248489523-00OtherBWC OHIO
P39229Medicare UPIN
ILK01948Medicare PIN
ILK01947Medicare PIN