Individual
MISS MARIA A TEJADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
3450 S ARCHER AVE, CHICAGO, IL 60608-6837
(773) 972-7462
Mailing address
3450 S ARCHER AVE, CHICAGO, IL 60608-6837
(773) 972-7462
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
209007360
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209007360
—
IL
Enumeration date
12/03/2008
Last updated
12/16/2012
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