Healthcare Provider Details

I. General information

NPI: 1417540527
Provider Name (Legal Business Name): DR. EMILY VILLEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE STE 4225
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

2650 RIDGE AVE # 4225
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1060
  • Fax: 847-733-5313
Mailing address:
  • Phone: 847-570-1778
  • Fax: 847-733-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209022064
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209022064
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: