Healthcare Provider Details

I. General information

NPI: 1932911443
Provider Name (Legal Business Name): MARIA DOMENICA CANZOLINO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 RYAN PKWY
ALGONQUIN IL
60102-4527
US

IV. Provider business mailing address

845 DOGWOOD LN
LAKE IN THE HILLS IL
60156-4651
US

V. Phone/Fax

Practice location:
  • Phone: 815-584-0976
  • Fax:
Mailing address:
  • Phone: 847-409-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209031281
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: