Healthcare Provider Details

I. General information

NPI: 1538825518
Provider Name (Legal Business Name): JOANNA PEREZ APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA MOSTELLER APRN, CNP

II. Dates (important events)

Enumeration Date: 11/13/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 S 80TH AVE STE 204
PALOS HEIGHTS IL
60463-1284
US

IV. Provider business mailing address

12255 S 80TH AVE STE 204
PALOS HEIGHTS IL
60463-1284
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-4233
  • Fax: 708-923-3405
Mailing address:
  • Phone: 708-923-4233
  • Fax: 708-923-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277003341
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024554
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: