Healthcare Provider Details

I. General information

NPI: 1386845246
Provider Name (Legal Business Name): BRIDGID SILVELA-BACALING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 WASHINGTON ST
WAUKEGAN IL
60085-4980
US

IV. Provider business mailing address

39302 N QUEENSBURY LN
BEACH PARK IL
60083-3018
US

V. Phone/Fax

Practice location:
  • Phone: 847-360-2470
  • Fax:
Mailing address:
  • Phone: 847-263-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.006561
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: