Provider Demographics
NPI:1114516754
Name:MEJOS, RAQUEL G (FNP-C)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:G
Last Name:MEJOS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-3107
Mailing Address - Country:US
Mailing Address - Phone:847-395-3322
Mailing Address - Fax:
Practice Address - Street 1:543 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-3107
Practice Address - Country:US
Practice Address - Phone:847-395-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI237456-30163W00000X
IL041453842163W00000X
IL209022534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse