Healthcare Provider Details

I. General information

NPI: 1013717834
Provider Name (Legal Business Name): TIARA CANG ESCONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 WILLOW SPRINGS RD
LA GRANGE IL
60525-2600
US

IV. Provider business mailing address

6711 HALEY CT
PLAINFIELD IL
60586-2605
US

V. Phone/Fax

Practice location:
  • Phone: 708-245-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.030995
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: