Individual provider Active NPI

Therese A Liebentritt, C.N.P.

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1386750453
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Practice address
7123 W Archer Ave
Chicago, IL 60638-2203
Phone
(773) 586-4506
Fax
(773) 586-5044
NPI assigned
Aug 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X IL Primary

Addresses

Primary practice location

7123 W Archer Ave
Chicago, IL 60638-2203

Mailing address

7123 W Archer Ave
Chicago, IL 60638-2203
Phone (773) 586-4506

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209000223ILMDNurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386750453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7123 W ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382203",
            "telephone_number": "773-586-4506",
            "fax_number": "773-586-5044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7123 W ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382203",
            "telephone_number": "773-586-4506",
            "fax_number": "773-586-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBENTRITT",
        "first_name": "THERESE",
        "middle_name": "A",
        "credential": "C.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.