Healthcare Provider Details

I. General information

NPI: 1174899967
Provider Name (Legal Business Name): NERINE TESS VINCENT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W MEDICAL CENTER DR STE B201
MCHENRY IL
60050-8417
US

IV. Provider business mailing address

4309 W MEDICAL CENTER DR STE B201
MCHENRY IL
60050-8417
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-7280
  • Fax: 815-759-4602
Mailing address:
  • Phone: 847-802-7280
  • Fax: 815-759-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036144272
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number64373
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number15504
License Number StateND
# 5
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35.138313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: