Healthcare Provider Details

I. General information

NPI: 1467924902
Provider Name (Legal Business Name): ANTHONY QUESADA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 ALGONQUIN RD STE 420C
ROLLING MEADOWS IL
60008-3250
US

IV. Provider business mailing address

934 W OXFORD CT
PALATINE IL
60067-6646
US

V. Phone/Fax

Practice location:
  • Phone: 847-345-2441
  • Fax: 847-474-9263
Mailing address:
  • Phone: 847-644-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209018558
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: