Healthcare Provider Details

I. General information

NPI: 1679089965
Provider Name (Legal Business Name): NANCY CONTRERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 CATON RIDGE DR
PLAINFIELD IL
60586-5624
US

IV. Provider business mailing address

1815 CATON RIDGE DR
PLAINFIELD IL
60586-5624
US

V. Phone/Fax

Practice location:
  • Phone: 815-516-6063
  • Fax:
Mailing address:
  • Phone: 815-436-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: