Healthcare Provider Details

I. General information

NPI: 1497620025
Provider Name (Legal Business Name): JAVIER MEDERO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

2594 HILLSBORO BLVD
AURORA IL
60503-6732
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4705
  • Fax:
Mailing address:
  • Phone: 630-779-9557
  • Fax: 630-779-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number041468524
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: