Healthcare Provider Details

I. General information

NPI: 1750252714
Provider Name (Legal Business Name): RAVEN ALEXIS CYNTHIA GUZMAN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E JACKSON ST
LOMBARD IL
60148-3709
US

IV. Provider business mailing address

111 N COUNTY FARM RD
WHEATON IL
60187-3988
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-7400
  • Fax:
Mailing address:
  • Phone: 630-682-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041553852
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: