Provider Demographics
NPI:1508339086
Name:FONTANEZ, ANNETTE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:FONTANEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 N MILWAUKEE AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3165
Mailing Address - Country:US
Mailing Address - Phone:847-663-9700
Mailing Address - Fax:847-663-9702
Practice Address - Street 1:7900 N MILWAUKEE AVE STE 18
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3165
Practice Address - Country:US
Practice Address - Phone:847-663-9700
Practice Address - Fax:847-663-9702
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF12180356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily