Provider Demographics
NPI:1548618085
Name:PODGORNY, ERIN (MS APN AGNP-C)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:PODGORNY
Suffix:
Gender:F
Credentials:MS APN AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W STATION ST UNIT 219
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-7602
Mailing Address - Country:US
Mailing Address - Phone:847-997-0142
Mailing Address - Fax:
Practice Address - Street 1:5801 S CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2300
Practice Address - Country:US
Practice Address - Phone:630-971-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014203363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health