Provider Demographics
NPI:1518521871
Name:WEINTRAUB, TAYLOR NICOLE
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:NICOLE
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 MOMENTUM PLACE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5326
Mailing Address - Country:US
Mailing Address - Phone:847-859-0300
Mailing Address - Fax:847-859-0301
Practice Address - Street 1:3000 N HALSTED ST STE 409
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9268
Practice Address - Country:US
Practice Address - Phone:773-281-9200
Practice Address - Fax:773-281-9201
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical