=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326544404
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REGINA TSANG APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2018
-----------------------------------------------------
Last Update Date | 04/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10258 SOUTHWEST HWY STE A
-----------------------------------------------------
City | CHICAGO RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60415-1361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-346-9533
-----------------------------------------------------
Fax | 708-499-4312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9500 BORMET DR STE 204
-----------------------------------------------------
City | MOKENA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60448-8399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-346-4040
-----------------------------------------------------
Fax | 708-346-3287
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 209.016915
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------