Healthcare Provider Details

I. General information

NPI: 1952619926
Provider Name (Legal Business Name): NANCY A RODRIGUEZ RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY A APONTE RN, CDCES

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S CENTRAL AVE
CHICAGO IL
60644-5059
US

IV. Provider business mailing address

645 S CENTRAL AVE
CHICAGO IL
60644-5059
US

V. Phone/Fax

Practice location:
  • Phone: 773-854-5218
  • Fax: 773-854-5587
Mailing address:
  • Phone: 773-854-5218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number209003425
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number041.211788
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: