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General NPI Number Information
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NPI Number | 1669386512
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Entity Type | Individual
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Provider Name | RENATO VIGILIA NATIVIDAD JR. REGISTERED NURSE
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Gender | Male
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 5000 S 5TH AVE
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City | HINES
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State | IL
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Zip | 60141-3030
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Country | US
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Telephone | 708-894-5071
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 ELLIOTT ST
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City | PARK RIDGE
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State | IL
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Zip | 60068-1301
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Country | US
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Telephone | 773-340-8022
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 041.396124
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License Number State | IL
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