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Individual

MARIA R REYES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD, WHNP, CNP

Contact information

Practice address
1645 W JACKSON BLVD, CHICAGO, IL 60612-3276
(312) 942-2777
(312) 942-2822
Mailing address
10824 S KOLMAR AVE, OAK LAWN, IL 60453-5619
(708) 424-0053
(312) 942-2822

Taxonomy

Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
209.001736
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
209.001736
APN LICENSURE
IL
01
REY104282734
NCC CERTIFICATION
IL
Enumeration date
05/08/2009
Last updated
12/18/2015
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