MEDICARE: MR. R RICHARD CORDERO APRN, 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
1	363LF0000X	Family Nurse Practitioner	F12190311	IL
2	363LF0000X	Family Nurse Practitioner	209.020666	IL
3	363LF0000X	Family Nurse Practitioner	277.003598	IL

General Provider Information

NPI Number	:	1538757695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. R RICHARD CORDERO APRN, NP-C

Provider Business Mailing Address
First Line	:	130 WASHINGTON AVE
Second Line	:
City	:	HIGHWOOD
State	:	IL
Zip	:	60040-1122
Country	:	US
Telephone Number	:	847-909-2004
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 WASHINGTON AVE
Second Line	:
City	:	HIGHWOOD
State	:	IL
Zip	:	60040-1122
Country	:	US
Telephone Number	:	847-909-2004
Fax Number	:

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

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	04/15/2025

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