Provider Demographics
NPI:1619434420
Name:ELITE PRACTITIONER LLC
Entity Type:Organization
Organization Name:ELITE PRACTITIONER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE NURSE OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:EMEM
Authorized Official - Middle Name:T
Authorized Official - Last Name:OBOT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:773-299-4804
Mailing Address - Street 1:151 N MICHIGAN AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7506
Mailing Address - Country:US
Mailing Address - Phone:773-299-8404
Mailing Address - Fax:
Practice Address - Street 1:151 N MICHIGAN AVE STE 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7506
Practice Address - Country:US
Practice Address - Phone:773-299-4804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of Service