Provider Demographics
NPI:1467792754
Name:DELA CRUZ, ANTOINETTE BORROMEO (CNP)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:BORROMEO
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:201 E HURON ST
Mailing Address - Street 2:GALTER PAVILLION, 11-140
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-926-6365
Mailing Address - Fax:312-695-2461
Practice Address - Street 1:201 E HURON ST
Practice Address - Street 2:GALTER PAVILLION, 11-140
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3197
Practice Address - Country:US
Practice Address - Phone:312-926-6365
Practice Address - Fax:312-695-2461
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008645363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care