Provider Demographics
NPI:1275275265
Name:GARCIA, MAYRA ELENA (APRN-FNP BC)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ELENA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:APRN-FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 PRICE CT
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-9390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3050 FINLEY RD STE 300B
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1369
Practice Address - Country:US
Practice Address - Phone:630-426-6018
Practice Address - Fax:630-426-3703
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner