Healthcare Provider Details

I. General information

NPI: 1679116651
Provider Name (Legal Business Name): TERESA L ALVAREZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA L COLANTO LPN

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N ASHLAND AVE
CHICAGO IL
60607-1802
US

IV. Provider business mailing address

140 N ASHLAND AVE
CHICAGO IL
60607-1802
US

V. Phone/Fax

Practice location:
  • Phone: 312-850-0500
  • Fax: 312-850-9095
Mailing address:
  • Phone: 312-850-0500
  • Fax: 312-850-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043112496
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: