Provider Demographics
NPI:1235734575
Name:CORDERO, NATHAN (NP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:CORDERO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2369
Mailing Address - Country:US
Mailing Address - Phone:630-915-8176
Mailing Address - Fax:
Practice Address - Street 1:2732 N HAMPDEN CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1612
Practice Address - Country:US
Practice Address - Phone:773-248-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041408157163W00000X
IL209022072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse