MEDICARE: EVA MADELYN CONTY-CUEVAS

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	209005814	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209005814	OTHER	IL	LICENSE

General Provider Information

NPI Number	:	1578670428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA MADELYN CONTY-CUEVAS

Provider Business Mailing Address
First Line	:	3319 N ELSTON AVE
Second Line	:	SUITE #100
City	:	CHICAGO
State	:	IL
Zip	:	60618-5811
Country	:	US
Telephone Number	:	773-751-7200
Fax Number	:	773-583-4295

Provider Business Practice Location Address
First Line	:	3319 N ELSTON AVE
Second Line	:	SUITE #100
City	:	CHICAGO
State	:	IL
Zip	:	60618-5811
Country	:	US
Telephone Number	:	773-751-7200
Fax Number	:	773-583-4295

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	04/15/2013

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Directions to “ EVA MADELYN CONTY-CUEVAS ” Practice Location

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