Healthcare Provider Details

I. General information

NPI: 1164183323
Provider Name (Legal Business Name): FELISA MAE DAVID GUEVARRA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

375 W DUNDEE RD APT 461
WHEELING IL
60090-2987
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7297
  • Fax:
Mailing address:
  • Phone: 224-475-5865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209022524
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022524
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: