Healthcare Provider Details

I. General information

NPI: 1427962059
Provider Name (Legal Business Name): YESSENIA BUZO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19070 EVERETT BLVD
MOKENA IL
60448-2018
US

IV. Provider business mailing address

16435 MAPLEWOOD CT
TINLEY PARK IL
60477-1632
US

V. Phone/Fax

Practice location:
  • Phone: 708-260-2030
  • Fax:
Mailing address:
  • Phone: 708-910-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209036673
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: