Provider Demographics
NPI:1558752881
Name:REYES, ROBERTA (RN APN)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:RN APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC3079
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-3235
Mailing Address - Fax:773-702-2451
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC3079
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-3235
Practice Address - Fax:773-702-2451
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041.283659163WX0800X
IL209.003594163WX0800X
IL209003594364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic