MEDICARE: JOY PRECIADO

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	209013390	IL

General Provider Information

NPI Number	:	1306216098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY PRECIADO

Provider Business Mailing Address
First Line	:	1405 E 12TH ST
Second Line	:	STE 300
City	:	MENDOTA
State	:	IL
Zip	:	61342-9010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 E 12TH ST
Second Line	:	STE 300
City	:	MENDOTA
State	:	IL
Zip	:	61342-9010
Country	:	US
Telephone Number	:	815-539-3141
Fax Number	:

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

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	10/07/2015

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Directions to “ JOY PRECIADO ” Practice Location

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