Provider Demographics
NPI:1477016202
Name:VERA, UBALDO (APRN)
Entity Type:Individual
Prefix:
First Name:UBALDO
Middle Name:
Last Name:VERA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W DIVISION ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3093
Mailing Address - Country:US
Mailing Address - Phone:773-252-4848
Mailing Address - Fax:773-252-8484
Practice Address - Street 1:2222 W DIVISION ST STE 110
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3093
Practice Address - Country:US
Practice Address - Phone:773-252-4848
Practice Address - Fax:773-252-8484
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041414162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041414162OtherRN