Individual
AZALEA VICENTENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3600 W FULLERTON AVE, CHICAGO, IL 60647-2319
(773) 782-2800
Mailing address
1464 S MICHIGAN AVE, 1402, CHICAGO, IL 60605-3711
(312) 560-8368
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209015196
IL
Other
Enumeration date
11/30/2016
Last updated
09/29/2020
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