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NPI Code Detail

MEDICARE: ANNA ROY NP-C

MEDICARE:   ANNA  ROY  NP-C
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
1363LA2200XAdult Health Nurse Practitioner041359915IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113543058OTHERILCAQH
2209011573OTHERILSTATE LICENSE - ADVANCED PRACTICE NURSE
3QXIPQ0000181327OTHERILAETNA BETTER HEALTH
4A0513030OTHERAANP - ADULT NURSE PRACTITIONER CERTIFICATION

General Provider Information

NPI Number : 1295128098
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA ROY NP-C
Provider Business Mailing Address
First Line : PO BOX 3603
Second Line :
City : OAK BROOK
State : IL
Zip : 60522-3603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2331 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4723
Country : US
Telephone Number : 773-772-7858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2015
Last Update Date : 03/07/2023

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Directions to “ ANNA ROY NP-C” Practice Location

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