Healthcare Provider Details

I. General information

NPI: 1235771684
Provider Name (Legal Business Name): MARIA PEKIC APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W 68TH ST
CHICAGO IL
60629-1813
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 950
CHICAGO IL
60611-2955
US

V. Phone/Fax

Practice location:
  • Phone: 773-434-4040
  • Fax:
Mailing address:
  • Phone: 312-694-7337
  • Fax: 312-695-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209019243
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: