Provider Demographics
NPI:1083222368
Name:ROSARIO, IZOLDA (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:IZOLDA
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W LAKE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1419
Mailing Address - Country:US
Mailing Address - Phone:312-513-9863
Mailing Address - Fax:
Practice Address - Street 1:501 W LAKE ST STE 207
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1419
Practice Address - Country:US
Practice Address - Phone:312-513-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021561363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty