Healthcare Provider Details

I. General information

NPI: 1255432290
Provider Name (Legal Business Name): ROSEMARY JUAREZ PACYGA FNP, NP-C, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W HARRISON ST
CHICAGO IL
60612-3741
US

IV. Provider business mailing address

620 THOMAS AVE
FOREST PARK IL
60130-1966
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-4680
  • Fax: 312-572-4659
Mailing address:
  • Phone: 708-366-1193
  • Fax: 312-572-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: