Individual
JULIE VICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
525 E CONGRESS PKWY, CRYSTAL LAKE, IL 60014
(630) 962-6280
Mailing address
3538 HOPEWELL PL, ELGIN, IL 60124-5705
(630) 962-6280
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209012352
IL
363LF0000X
Family Nurse Practitioner
209012352
IL
Other
Enumeration date
12/26/2014
Last updated
01/10/2024
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