Healthcare Provider Details

I. General information

NPI: 1295380152
Provider Name (Legal Business Name): CLAUDELIA CANO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSALVINA CANO

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 CERMAK RD
BERWYN IL
60402-2112
US

IV. Provider business mailing address

PO BOX 746715
ATLANTA GA
30374-6715
US

V. Phone/Fax

Practice location:
  • Phone: 708-484-8090
  • Fax:
Mailing address:
  • Phone: 708-484-8090
  • Fax: 708-445-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: