Healthcare Provider Details

I. General information

NPI: 1811887102
Provider Name (Legal Business Name): MARYCARMEN RIVERA URBINA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S MAPLE AVE
OAK PARK IL
60304-1022
US

IV. Provider business mailing address

524 48TH AVE
BELLWOOD IL
60104-1728
US

V. Phone/Fax

Practice location:
  • Phone: 708-660-6000
  • Fax:
Mailing address:
  • Phone: 312-307-5192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041549248
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: