Provider Demographics
NPI:1275803777
Name:CHUA, MERLYN SERRANO
Entity Type:Individual
Prefix:
First Name:MERLYN
Middle Name:SERRANO
Last Name:CHUA
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 1:1816 S INDIANA AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2664
Mailing Address - Country:US
Mailing Address - Phone:312-451-4094
Mailing Address - Fax:
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008325363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner