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NPI Code Detail

MEDICARE: NATHAN CORDERO NP

MEDICARE: NATHAN CORDERO NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse041408157IL
2363L00000XNurse Practitioner209022072IL

General Provider Information

NPI Number : 1235734575
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN CORDERO NP
Provider Business Mailing Address
First Line : 5531 N CAMPBELL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2369
Country : US
Telephone Number : 630-915-8176
Fax Number :
Provider Business Practice Location Address
First Line : 2732 N HAMPDEN CT
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1612
Country : US
Telephone Number : 773-248-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2020
Last Update Date : 12/03/2020

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