MEDICARE: MRS. ROXANA CALAFOS APN

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	209013078	IL

General Provider Information

NPI Number	:	1033586342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROXANA CALAFOS APN

Provider Business Mailing Address
First Line	:	480 E ROOSEVELT RD STE 105
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3969
Country	:	US
Telephone Number	:	630-492-1965
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 E ROOSEVELT RD STE 105
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3969
Country	:	US
Telephone Number	:	630-492-1965
Fax Number	:	630-492-0933

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	04/23/2021

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