Provider Demographics
NPI:1548614878
Name:ONG-PEREZ, MARY ROSE SUPETRAN (RN)
Entity Type:Individual
Prefix:
First Name:MARY ROSE
Middle Name:SUPETRAN
Last Name:ONG-PEREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 HARBOR CT
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-3753
Mailing Address - Country:US
Mailing Address - Phone:630-670-4290
Mailing Address - Fax:
Practice Address - Street 1:1133 HARBOR CT
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3753
Practice Address - Country:US
Practice Address - Phone:630-670-4290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0041-293484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse