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General NPI Number Information
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NPI Number | 1609396860
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Entity Type | Individual
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Provider Name | ENES MUGNOLO AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 06/20/2017
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Provider Practice Location Address
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Address Line | 1088 KUFRIN WAY
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City | LOMBARD
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State | IL
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Zip | 60148-3429
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Country | US
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Telephone | 630-484-5094
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7405
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City | VILLA PARK
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State | IL
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Zip | 60181-7405
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Country | US
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Telephone | 630-484-5094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209.014796
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209.014796
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License Number State | IL
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