Provider Demographics
NPI:1881338705
Name:ILUNDAIN, COURTNEY (APN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ILUNDAIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 N GREENVIEW AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2015
Mailing Address - Country:US
Mailing Address - Phone:989-600-8790
Mailing Address - Fax:
Practice Address - Street 1:4254 W 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4642
Practice Address - Country:US
Practice Address - Phone:773-582-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041431635163WP2201X
IL209026212363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care