Healthcare Provider Details

I. General information

NPI: 1750105730
Provider Name (Legal Business Name): STEPHANIE SALGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W FULLERTON AVE
CHICAGO IL
60647-2319
US

IV. Provider business mailing address

3600 W FULLERTON AVE
CHICAGO IL
60647-2319
US

V. Phone/Fax

Practice location:
  • Phone: 773-782-2800
  • Fax:
Mailing address:
  • Phone: 773-782-2800
  • Fax: 773-782-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041543192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: