Provider Demographics
NPI:1124568720
Name:QUEYPO, MARIA TERESA
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:
Last Name:QUEYPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-0355
Mailing Address - Country:US
Mailing Address - Phone:847-774-2251
Mailing Address - Fax:
Practice Address - Street 1:604 ROLLINS RD UNIT 355
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-4401
Practice Address - Country:US
Practice Address - Phone:847-774-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.290711163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse