Healthcare Provider Details

I. General information

NPI: 1669221115
Provider Name (Legal Business Name): RALITSA PETROVA TRAJANOV NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 MACOM DR STE 101
NAPERVILLE IL
60564-3206
US

IV. Provider business mailing address

1309 MACOM DR STE 101
NAPERVILLE IL
60564-3206
US

V. Phone/Fax

Practice location:
  • Phone: 630-236-8018
  • Fax:
Mailing address:
  • Phone: 630-236-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209029050
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: