Provider Demographics
NPI:1073531547
Name:ORTEGA, MICHELLE GAA (APN/CNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:GAA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:APN/CNP
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:GAA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:731 S. IL ROUTE 21
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-566-3337
Mailing Address - Fax:847-816-3166
Practice Address - Street 1:731 S. IL ROUTE 21
Practice Address - Street 2:SUITE 130
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-566-3337
Practice Address - Fax:847-816-3166
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005095363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ09516Medicare UPIN