Healthcare Provider Details

I. General information

NPI: 1639801533
Provider Name (Legal Business Name): RICHIE TORRES APN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 08/29/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 W IRVING PARK RD
CHICAGO IL
60641-2718
US

IV. Provider business mailing address

PO BOX 746721
ATLANTA GA
30374-6721
US

V. Phone/Fax

Practice location:
  • Phone: 773-724-6200
  • Fax: 773-866-8015
Mailing address:
  • Phone: 127-339-7303
  • Fax: 773-866-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041384019
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.025417
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: