Healthcare Provider Details

I. General information

NPI: 1710595012
Provider Name (Legal Business Name): TESSA CAPPEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W DIVERSEY PKWY STE 215
CHICAGO IL
60614-1682
US

IV. Provider business mailing address

25156 N BARSUMIAN DR
TOWER LAKES IL
60010-1117
US

V. Phone/Fax

Practice location:
  • Phone: 773-906-4546
  • Fax: 773-304-4549
Mailing address:
  • Phone: 708-668-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.035219
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: