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Christian Provenza
Student in an Organized Health Care Education/Training Program in North Chicago, Illinois
NPI 1659906741

Christian Provenza is a Student in an Organized Health Care Education/Training Program based in North Chicago, IL. Christian Provenza practices in North Chicago, IL. The NPI Number for Christian Provenza is 1659906741 and holds a License No. (Illinois).

The current practice location address for Christian Provenza is 3333 Green Bay Rd, North Chicago, IL and can be reached out via phone at 847-578-3288.

Location: 3333 Green Bay Rd, North Chicago, IL, 60064-3037
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1659906741
Provider Name
Christian Provenza
Credential
Provider Entity Type
Individual
Gender
Male
Address
3333 Green Bay Rd, North Chicago, IL, 60064-3037
Phone Number
847-578-3288
Fax Number
Provider Enumeration Date
03/09/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3333 Green Bay Rd
City
North Chicago
State
Illinois
Zip
60064-3037
Phone Number
847-578-3288
Fax Number
person
Provider Business Mailing Address Details
Address
3333 Green Bay Rd
City
North Chicago
State
Illinois
Zip
60064-3037
Phone Number
847-578-3288
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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