Individual
PETRA YENGWIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612-7232
(858) 349-1496
Mailing address
861 N TAMARAC BLVD, ADDISON, IL 60101-1695
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209021444
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209021444
LICENSE NUMBER
IL
Enumeration date
03/15/2021
Last updated
03/07/2024
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