Healthcare Provider Details

I. General information

NPI: 1043090335
Provider Name (Legal Business Name): MARGARET SEMPREVIVO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 N BROADWAY ST
CHICAGO IL
60613-4567
US

IV. Provider business mailing address

2317 N ROCKWELL ST APT 1B
CHICAGO IL
60647-3042
US

V. Phone/Fax

Practice location:
  • Phone: 773-496-4433
  • Fax:
Mailing address:
  • Phone: 914-417-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: