Healthcare Provider Details

I. General information

NPI: 1811647829
Provider Name (Legal Business Name): REGINE PHILIZAIRE CAMACHO APRN, MSN, AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINE PHILIZAIRE CAMACHO APRN, MSN, AGPCNP-C

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1950
CHICAGO IL
60611-3907
US

IV. Provider business mailing address

6352 N LINCOLN AVE
CHICAGO IL
60659-1213
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3185
  • Fax: 312-926-7382
Mailing address:
  • Phone: 872-208-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209024946
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.024946
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209024946
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024946
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: