Healthcare Provider Details

I. General information

NPI: 1801557319
Provider Name (Legal Business Name): CLAUDIA A ROLDAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 09/25/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 OAK PARK AVE
BERWYN IL
60402-4661
US

IV. Provider business mailing address

1736 N WASHTENAW AVE
CHICAGO IL
60647-0724
US

V. Phone/Fax

Practice location:
  • Phone: 708-575-6757
  • Fax: 877-653-2695
Mailing address:
  • Phone: 773-443-5156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041400346
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: