Provider Demographics
NPI:1366000341
Name:DE ROSAS, MARIA THERESA (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:
Last Name:DE ROSAS
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 N NOTTINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-3825
Mailing Address - Country:US
Mailing Address - Phone:312-800-3222
Mailing Address - Fax:
Practice Address - Street 1:715 W LAKE ST STE 104
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2082
Practice Address - Country:US
Practice Address - Phone:630-366-6681
Practice Address - Fax:630-366-6550
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019401363L00000X
IL209019401363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner