Individual
MARIAELENA J. FAGADORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4254 W 55TH ST, CHICAGO, IL 60632-4642
(773) 582-5200
(773) 582-2772
Mailing address
4254 W 55TH ST, CHICAGO, IL 60632-4642
(773) 582-5200
(773) 582-2772
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
R45506
NM
363LP0200X
Pediatric Nurse Practitioner
Primary
209-015320
IL
363LP0200X
Pediatric Nurse Practitioner
9244538
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307963500
—
FL
05
—
92187315
—
NM
Enumeration date
07/12/2005
Last updated
04/11/2017
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