Individual
NICHOLE SCHUPBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(231) 590-0435
Mailing address
2510 N WAYNE AVE APT 209, CHICAGO, IL 60614-2143
(231) 590-0435
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
041422092
IL
363LP0200X
Pediatric Nurse Practitioner
Primary
RN301093
GA
Other
Enumeration date
04/06/2020
Last updated
05/20/2021
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