Healthcare Provider Details

I. General information

NPI: 1710236815
Provider Name (Legal Business Name): MARISSA DE LA PAZ AMAYA APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E. WOODFIELD ROAD 300
SCHAUMBURG IL
60173
US

IV. Provider business mailing address

1632 W CENTRAL RD
ARLINGTON HEIGHTS IL
60005-2407
US

V. Phone/Fax

Practice location:
  • Phone: 847-605-9500
  • Fax: 847-605-8700
Mailing address:
  • Phone: 847-618-2500
  • Fax: 847-253-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: