Individual
MARK PEREZ AGUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
2650 RIDGE AVE., DEPT. OF ANESTHESIA, EVANSTON, IL 60201-1057
(847) 570-2760
(847) 570-2921
Mailing address
2650 RIDGE AVE., DEPT. OF ANESTHESIA, EVANSTON, IL 60201-1057
(847) 570-2760
(847) 570-2921
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209019626
IL
363LA2100X
Acute Care Nurse Practitioner
209019626
IL
Other
Enumeration date
08/20/2021
Last updated
09/17/2021
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