Individual
PATRICIA A RAETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN/MSN/APN
Contact information
Practice address
259 E ERIE ST, CHICAGO, IL 60611
(312) 695-8143
(312) 695-4430
Mailing address
25 WINFIELD ROAD, WINFIELD, IL 60190
(630) 614-4066
(630) 614-4069
Taxonomy
Speciality
Code
Description
License number
State
364SN0800X
Neuroscience Clinical Nurse Specialist
Primary
209001060
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
01
—
36-3149833
TAX IDENTIFICATION NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
01
—
CA4748
MEDICARE RR GROUP NUMBER
IL
01
—
P00686148
MEDICARE RAILROAD
IL
Enumeration date
08/14/2006
Last updated
07/25/2018
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