Provider Demographics
NPI:1366508053
Name:ARAUZ, YETZENIA ARAMIS (CNP)
Entity Type:Individual
Prefix:
First Name:YETZENIA
Middle Name:ARAMIS
Last Name:ARAUZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 NORTH 41ST STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62201
Mailing Address - Country:US
Mailing Address - Phone:618-482-4015
Mailing Address - Fax:618-482-4806
Practice Address - Street 1:2568 NORTH 41ST STREET
Practice Address - Street 2:
Practice Address - City:FAIRMONT CITY
Practice Address - State:IL
Practice Address - Zip Code:62201
Practice Address - Country:US
Practice Address - Phone:618-482-4015
Practice Address - Fax:618-482-4806
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041290396163W00000X
IL209002371363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse