MEDICARE: MS. ROSEMARY JUAREZ PACYGA FNP, NP-C, MS

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		IL

General Provider Information

NPI Number	:	1255432290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSEMARY JUAREZ PACYGA FNP, NP-C, MS

Provider Business Mailing Address
First Line	:	620 THOMAS AVE
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-1966
Country	:	US
Telephone Number	:	708-366-1193
Fax Number	:	312-572-4659

Provider Business Practice Location Address
First Line	:	2020 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3741
Country	:	US
Telephone Number	:	312-572-4680
Fax Number	:	312-572-4659

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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