MEDICARE: DOMENICA REDA FNP-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	163W00000X	Registered Nurse	041.444908	IL
2	363LF0000X	Family Nurse Practitioner	209025545	IL

General Provider Information

NPI Number	:	1740914894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMENICA REDA FNP-C

Provider Business Mailing Address
First Line	:	303 E WACKER DR STE 1127
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-5215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2127
Country	:	US
Telephone Number	:	312-429-5725
Fax Number	:

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

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	12/18/2024

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