Healthcare Provider Details

I. General information

NPI: 1205643590
Provider Name (Legal Business Name): BIANCA RIOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR EMERGENCY ROOM
CHICAGO IL
60657
US

IV. Provider business mailing address

1800 CLARENCE AVE APT 1F
BERWYN IL
60402-1974
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3000
  • Fax:
Mailing address:
  • Phone: 630-712-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041455197
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: