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NPI Code Detail

MEDICARE: MARIAELENA J. FAGADORE CNP

MEDICARE: MARIAELENA J. FAGADORE CNP
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
1163WP0200XPediatric Registered NurseR45506NM
2363LP0200XPediatric Nurse Practitioner9244538FL
3363LP0200XPediatric Nurse Practitioner209-015320IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861490138
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAELENA J. FAGADORE CNP
Provider Business Mailing Address
First Line : 4254 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4642
Country : US
Telephone Number : 773-582-5200
Fax Number : 773-582-2772
Provider Business Practice Location Address
First Line : 4254 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4642
Country : US
Telephone Number : 773-582-5200
Fax Number : 773-582-2772
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 04/11/2017

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Directions to “ MARIAELENA J. FAGADORE CNP” Practice Location

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