Healthcare Provider Details

I. General information

NPI: 1790270965
Provider Name (Legal Business Name): EMILY THERESE OPIOLA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12816 S MUSKEGON AVE
CHICAGO IL
60633-1243
US

IV. Provider business mailing address

12816 S MUSKEGON AVE
CHICAGO IL
60633-1243
US

V. Phone/Fax

Practice location:
  • Phone: 630-310-6212
  • Fax:
Mailing address:
  • Phone: 630-310-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.017833
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: