Individual
MR. DOUGLAS NYENKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, PMHNP-BC
Contact information
Practice address
10406 S WESTERN AVE, CHICAGO, IL 60643-2508
(312) 857-4475
(773) 666-7241
Mailing address
10406 S WESTERN AVE, CHICAGO, IL 60643-2508
(312) 857-4475
(773) 666-7241
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209026907
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659135416
BEVERLY PSYCHIATRIC SERVICES LLC
—
Enumeration date
01/20/2023
Last updated
09/02/2025
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