Provider Demographics
NPI:1073514972
Name:SAVINO, TERESA J (NP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:SAVINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W LAWRENCE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5017
Mailing Address - Country:US
Mailing Address - Phone:773-751-1704
Mailing Address - Fax:773-751-4175
Practice Address - Street 1:1015 W LAWRENCE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5017
Practice Address - Country:US
Practice Address - Phone:773-751-1704
Practice Address - Fax:773-751-4175
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000288363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP33985Medicare UPIN