Provider Demographics
NPI:1720239734
Name:POPOVICH, JUDITH MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARIE
Last Name:POPOVICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE # MC6054
Mailing Address - Street 2:ROOM 623
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-5290
Mailing Address - Fax:773-702-1196
Practice Address - Street 1:5841 S MARYLAND AVE # MC6054
Practice Address - Street 2:ROOM 623
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-5290
Practice Address - Fax:773-702-1196
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily