MEDICARE: MRS. MARGARET EMILIA REYES APN

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	41133677	IL

General Provider Information

NPI Number	:	1891728614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGARET EMILIA REYES APN

Provider Business Mailing Address
First Line	:	2423 S AUSTIN BLVD
Second Line	:	ROOM 213
City	:	CICERO
State	:	IL
Zip	:	60804-2616
Country	:	US
Telephone Number	:	708-656-1130
Fax Number	:	708-656-1129

Provider Business Practice Location Address
First Line	:	6258 N MAPLEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2806
Country	:	US
Telephone Number	:	773-764-4165
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/14/2013

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