MEDICARE: MS. RACHEL ONGSANSOY NP

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	363LP2300X	Primary Care Nurse Practitioner	209007218	IL

General Provider Information

NPI Number	:	1437509262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL ONGSANSOY NP

Provider Business Mailing Address
First Line	:	5425 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3203
Country	:	US
Telephone Number	:	773-427-0298
Fax Number	:	773-427-0299

Provider Business Practice Location Address
First Line	:	5425 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3203
Country	:	US
Telephone Number	:	773-427-0298
Fax Number	:	773-427-0299

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/21/2016

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