Provider Demographics
NPI:1861705717
Name:GRUDE, NINA ELISE (NP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:ELISE
Last Name:GRUDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S WOOD ST
Mailing Address - Street 2:RM 235-SOUTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4300
Mailing Address - Country:US
Mailing Address - Phone:312-413-0786
Mailing Address - Fax:312-355-4100
Practice Address - Street 1:912 S WOOD ST
Practice Address - Street 2:RM 235-SOUTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4300
Practice Address - Country:US
Practice Address - Phone:312-413-0786
Practice Address - Fax:312-355-4100
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009082363LA2100X
IL041.396801163W00000X
MA2262499363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse