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NPI Code Detail

MEDICARE: NDEMBELEKI ROSA FREITAS APN

MEDICARE: NDEMBELEKI ROSA FREITAS APN
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
1363LF0000XFamily Nurse Practitioner209015397IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12016015100OTHERBOARD ID NUMBER

General Provider Information

NPI Number : 1992241061
Entity Type Code : Individual
Provider Name (Legal Business Name) : NDEMBELEKI ROSA FREITAS APN
Provider Business Mailing Address
First Line : 6150 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60660-2538
Country : US
Telephone Number : 773-274-9337
Fax Number : 773-388-8829
Provider Business Practice Location Address
First Line : 6150 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60660-2538
Country : US
Telephone Number : 773-274-9337
Fax Number : 773-388-8829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2017
Last Update Date : 10/27/2025

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