Provider Demographics
NPI:1225753270
Name:RODRIGUEZ, ISAMAR SAMANTHA (RN)
Entity Type:Individual
Prefix:
First Name:ISAMAR
Middle Name:SAMANTHA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 ARBOR LN STE 116
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2104
Mailing Address - Country:US
Mailing Address - Phone:773-332-4623
Mailing Address - Fax:
Practice Address - Street 1:1323 BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5604
Practice Address - Country:US
Practice Address - Phone:224-289-6229
Practice Address - Fax:708-364-0480
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041467417163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult