Healthcare Provider Details

I. General information

NPI: 1487936142
Provider Name (Legal Business Name): MAYRA CORREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BARRINGTON RD 1ST FL
HOFFMAN ESTATES IL
60169-1020
US

IV. Provider business mailing address

1555 BARRINGTON RD 1ST FL
HOFFMAN ESTATES IL
60169-1020
US

V. Phone/Fax

Practice location:
  • Phone: 224-299-4222
  • Fax:
Mailing address:
  • Phone: 224-299-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: