Provider Demographics
NPI:1083814529
Name:RIVERA, NANCY SLONE (NP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:SLONE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:SLONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:1900 SILVER CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9509
Mailing Address - Country:US
Mailing Address - Phone:847-494-3158
Mailing Address - Fax:
Practice Address - Street 1:15 HOLE IN THE WALL RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-8772
Practice Address - Country:US
Practice Address - Phone:847-494-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.0065596163WE0900X
IL209006596363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy