| Doctor Name: | MRS. ELIZABETH JANNUSCH |
| NPI Number: | 1104295666 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 209.013106 |
| Business Practice Address: | 800 Biesterfield Rd Brock Ste 4011 Elk Grove Village, IL - 600073361 |
| Business Phone Number: | 8479813694 |
| Business Fax Number: | 8479816508 |
| Mailing Address: | 800 Biesterfield Rd, Brock Ste 4011 ELK GROVE VILLAGE |
| State: | IL |
| Postal Code: | 600073361 |
| Phone Number: | 8479813694 |
| Fax Number: | 8479816508 |
| NPI Enumeration Date: | 09/15/2015 |
| NPI Last Update Date: | 09/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209.013106 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |