MEDICARE: JOSEFINA RAMOS LARDUET

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	209.029271	IL

General Provider Information

NPI Number	:	1306613252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEFINA RAMOS LARDUET

Provider Business Mailing Address
First Line	:	1340 REMINGTON RD STE S
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173-4821
Country	:	US
Telephone Number	:	872-710-5116
Fax Number	:	773-840-7394

Provider Business Practice Location Address
First Line	:	2859 S PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-5095
Country	:	US
Telephone Number	:	815-558-9094
Fax Number	:	773-840-7394

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	09/16/2024

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