MEDICARE: MS. ALICIA ESTRADA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.027006	IL

General Provider Information

NPI Number	:	1003510751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICIA ESTRADA FNP

Provider Business Mailing Address
First Line	:	4952 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2693
Country	:	US
Telephone Number	:	773-614-7296
Fax Number	:	866-707-2267

Provider Business Practice Location Address
First Line	:	4952 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2693
Country	:	US
Telephone Number	:	773-614-7296
Fax Number	:	866-707-2267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	08/22/2024

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