Healthcare Provider Details

I. General information

NPI: 1235734575
Provider Name (Legal Business Name): NATHAN CORDERO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 N HAMPDEN CT
CHICAGO IL
60614-1612
US

IV. Provider business mailing address

5531 N CAMPBELL AVE
CHICAGO IL
60625-2369
US

V. Phone/Fax

Practice location:
  • Phone: 773-248-6000
  • Fax:
Mailing address:
  • Phone: 630-915-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209022072
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041408157
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: