MEDICARE: MISS YASMIN AGUILAR PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.028892	IL

General Provider Information

NPI Number	:	1053188433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS YASMIN AGUILAR PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 388556
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-8556
Country	:	US
Telephone Number	:	708-304-3010
Fax Number	:	708-575-5333

Provider Business Practice Location Address
First Line	:	6015 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4357
Country	:	US
Telephone Number	:	708-304-3010
Fax Number	:	708-575-5333

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

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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