Provider Demographics
NPI:1417168022
Name:CHAMNANKIT, POOME (APN-CNP)
Entity Type:Individual
Prefix:
First Name:POOME
Middle Name:
Last Name:CHAMNANKIT
Suffix:
Gender:M
Credentials:APN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 4945
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2332
Mailing Address - Fax:847-570-1436
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:ICU, RM 3935A
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2428
Practice Address - Fax:847-570-1436
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005563363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine