MEDICARE: BANESA CHAVEZ APRN

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	209021489	IL

General Provider Information

NPI Number	:	1780297457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BANESA CHAVEZ APRN

Provider Business Mailing Address
First Line	:	7945 S HARLEM AVE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1600
Country	:	US
Telephone Number	:	708-422-7100
Fax Number	:	708-422-7364

Provider Business Practice Location Address
First Line	:	7945 S HARLEM AVE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1600
Country	:	US
Telephone Number	:	708-422-7100
Fax Number	:	708-422-7364

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/02/2024

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