Healthcare Provider Details

I. General information

NPI: 1811828635
Provider Name (Legal Business Name): RHON PERALTA APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 N NASHOTAH AVE APT 103
CHICAGO IL
60631-2722
US

IV. Provider business mailing address

5912 N NASHOTAH AVE APT 103
CHICAGO IL
60631-2722
US

V. Phone/Fax

Practice location:
  • Phone: 773-592-8494
  • Fax:
Mailing address:
  • Phone: 773-592-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209035054
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209035054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: