Healthcare Provider Details

I. General information

NPI: 1902416829
Provider Name (Legal Business Name): ADRIENNE CASTILLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 309
CHICAGO IL
60612-3844
US

IV. Provider business mailing address

1725 W HARRISON ST STE 309
CHICAGO IL
60612-3844
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-8011
  • Fax: 312-942-2253
Mailing address:
  • Phone: 312-942-8011
  • Fax: 312-942-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209019244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: