Healthcare Provider Details

I. General information

NPI: 1669505020
Provider Name (Legal Business Name): ANGELITA OQUENDO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 N SOUTHPORT AVE
CHICAGO IL
60613-3709
US

IV. Provider business mailing address

3637 N SOUTHPORT AVE
CHICAGO IL
60613-3709
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-5282
  • Fax:
Mailing address:
  • Phone: 773-348-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-006451
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: