Healthcare Provider Details

I. General information

NPI: 1407254337
Provider Name (Legal Business Name): LADY ARIANE GARCIA RN,CCRN,MSN,FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LADY ARIANE GAVIOLA

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LUTHER LN STE 1170
PARK RIDGE IL
60068-1270
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 844-376-3876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209012133
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: