Healthcare Provider Details

I. General information

NPI: 1548494255
Provider Name (Legal Business Name): MARIA R REYES PHD, WHNP, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 W JACKSON BLVD
CHICAGO IL
60612-3276
US

IV. Provider business mailing address

10824 S KOLMAR AVE
OAK LAWN IL
60453-5619
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-2777
  • Fax: 312-942-2822
Mailing address:
  • Phone: 708-424-0053
  • Fax: 312-942-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209.001736
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: